Healthcare Provider Details

I. General information

NPI: 1295076917
Provider Name (Legal Business Name): PRIME PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14608 S HARRELLS FERRY RD
BATON ROUGE LA
70816-2926
US

IV. Provider business mailing address

4606 JONES CREEK RD SUITE 150
BATON ROUGE LA
70817-1554
US

V. Phone/Fax

Practice location:
  • Phone: 225-388-5534
  • Fax: 225-388-5537
Mailing address:
  • Phone: 225-388-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number06937
License Number StateLA

VIII. Authorized Official

Name: TRINITY PURVIS SALTER
Title or Position: PHYSICAL THERAPY/OWNER
Credential: PT, DMT
Phone: 225-388-5534