Basic Information
| Provider Information | |||||||||
| NPI: | 1386180891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAUTREAU | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 JERLYN DR | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707265105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253376623 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8448 SIEGEN LN | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257570164 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2017 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173C00000X | LA7039 | LA | Y | Other Service Providers | Reflexologist |
No ID Information.