MEDICARE: HEALTH QUEST PHYSICAL THERAPY-PRAIRIEVILLE CLINIC, LLC

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

General Provider Information

NPI Number	:	1699857870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH QUEST PHYSICAL THERAPY-PRAIRIEVILLE CLINIC, LLC

Provider Business Mailing Address
First Line	:	17534 OLD JEFFERSON HWY
Second Line	:	SUITE A-1
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3929
Country	:	US
Telephone Number	:	225-673-4370
Fax Number	:	225-673-2241

Provider Business Practice Location Address
First Line	:	17534 OLD JEFFERSON HWY
Second Line	:	SUITE A-1
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3929
Country	:	US
Telephone Number	:	225-673-4370
Fax Number	:	225-673-2241

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MITCHELL MULA
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	225-673-4370

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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