Provider Demographics
NPI:1609389378
Name:ROGER, JUDITH FEROLIN (PT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:FEROLIN
Last Name:ROGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:BADE
Other - Last Name:FEROLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:147 RUE ST RACHEL DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5959
Mailing Address - Country:US
Mailing Address - Phone:985-226-8988
Mailing Address - Fax:
Practice Address - Street 1:147 RUE ST RACHEL DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5959
Practice Address - Country:US
Practice Address - Phone:985-226-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01257F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty