Healthcare Provider Details

I. General information

NPI: 1265589451
Provider Name (Legal Business Name): AMITE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N 2ND ST
AMITE LA
70422-2408
US

IV. Provider business mailing address

PO BOX 398
AMITE LA
70422-0398
US

V. Phone/Fax

Practice location:
  • Phone: 985-748-7878
  • Fax: 985-748-2837
Mailing address:
  • Phone: 985-748-7878
  • Fax: 985-748-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number140
License Number StateLA

VIII. Authorized Official

Name: PROF. MARVIN BRUCE NEAL JR.
Title or Position: PRESIDENT
Credential: P.T.
Phone: 985-748-7878