Healthcare Provider Details

I. General information

NPI: 1174550560
Provider Name (Legal Business Name): CHRIS PURVIS PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11320 INDUSTRIPLEX BOULEVARD
BATON ROUGE LA
70809
US

IV. Provider business mailing address

11320 INDUSTRIPLEX BOULEVARD
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 225-295-8183
  • Fax: 225-752-2937
Mailing address:
  • Phone: 225-295-8183
  • Fax: 225-752-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01016
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: