MEDICARE: ST. MARTINVILLE PHYSICAL THERAPY CLINIC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1447328224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARTINVILLE PHYSICAL THERAPY CLINIC

Provider Business Mailing Address
First Line	:	400 S MAIN ST
Second Line	:	SUITE D
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-4544
Country	:	US
Telephone Number	:	337-394-3757
Fax Number	:	337-394-3758

Provider Business Practice Location Address
First Line	:	400 S MAIN ST
Second Line	:	SUITE D
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-4544
Country	:	US
Telephone Number	:	337-394-3757
Fax Number	:	337-394-3758

Authorized Official
Title or Position	:	OWNER&PRESIDENT
Name	:	MR. CONWAY PAUL GEOFFROY
Credential	:	P.T.
Telephone Number	:	337-394-3757

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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