Healthcare Provider Details

I. General information

NPI: 1255994539
Provider Name (Legal Business Name): FYZICAL OF BATON ROUGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 DIJON DR
BATON ROUGE LA
70808-4311
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD STE 2222
BATON ROUGE LA
70810-7828
US

V. Phone/Fax

Practice location:
  • Phone: 225-408-6900
  • Fax: 225-408-6946
Mailing address:
  • Phone: 225-408-6900
  • Fax: 225-408-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDIE TUCKER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 225-408-6900