Healthcare Provider Details

I. General information

NPI: 1144782905
Provider Name (Legal Business Name): FYZICAL OF ALEXANDRIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WINDERMERE BLVD STE A
ALEXANDRIA LA
71303-3538
US

IV. Provider business mailing address

221 WINDERMERE BLVD
ALEXANDRIA LA
71303-3538
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE TRANTHAM
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 318-427-3308