Healthcare Provider Details

I. General information

NPI: 1801867833
Provider Name (Legal Business Name): PEDIATRIC THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JACKSON ST
ALEXANDRIA LA
71301-6929
US

IV. Provider business mailing address

1300 JACKSON ST
ALEXANDRIA LA
71301-6929
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-3848
  • Fax: 318-448-3953
Mailing address:
  • Phone: 318-448-3848
  • Fax: 318-448-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY DEBEVEC
Title or Position: EXECUTIVE DIRECTOR
Credential: LOTR
Phone: 318-448-3848