Provider Demographics
NPI:1447473616
Name:TALBOTT, SHAUN LAMAR
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:LAMAR
Last Name:TALBOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 VENUS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4906
Mailing Address - Country:US
Mailing Address - Phone:504-288-5161
Mailing Address - Fax:
Practice Address - Street 1:4015 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1629
Practice Address - Country:US
Practice Address - Phone:504-837-6447
Practice Address - Fax:504-833-8088
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist