Basic Information
| Provider Information | |||||||||
| NPI: | 1417281908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEWETT | ||||||||
| FirstName: | LATONYIA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9511 CRESTVIEW DRIVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252240114 | ||||||||
| FaxNumber: | 8887110441 | ||||||||
| Practice Location | |||||||||
| Address1: | 9511 CRESTVIEW DRIVE | ||||||||
| Address2: | STE B | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708363246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252240114 | ||||||||
| FaxNumber: | 8887110441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 242722 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | 6054 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 10780R | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10780R | 01 | LA | LOUISIANA PHYSICAL THERAPY BOARD | OTHER |