MEDICARE: WILLIAM CLOUGHLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	02225R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02225R	OTHER	LA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1114585130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CLOUGHLEY PT

Provider Business Mailing Address
First Line	:	1160 HOSPITAL RD STE 100
Second Line	:
City	:	NEW ROADS
State	:	LA
Zip	:	70760-2633
Country	:	US
Telephone Number	:	225-638-4455
Fax Number	:	225-208-6172

Provider Business Practice Location Address
First Line	:	1160 HOSPITAL RD STE 100
Second Line	:
City	:	NEW ROADS
State	:	LA
Zip	:	70760-2633
Country	:	US
Telephone Number	:	225-638-4455
Fax Number	:	225-208-6172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/04/2019

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Directions to “ WILLIAM CLOUGHLEY PT” Practice Location

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