Healthcare Provider Details

I. General information

NPI: 1063473163
Provider Name (Legal Business Name): THERAPEUTIC CONCEPTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15126 HWY 21 S
BOGALUSA LA
70427-7966
US

IV. Provider business mailing address

15126 HWY 21 S
BOGALUSA LA
70427-7966
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-3549
  • Fax: 985-732-3543
Mailing address:
  • Phone: 985-732-3549
  • Fax: 985-732-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT01524R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY TRAVIS
Title or Position: OWNER PHYSICAL THERAPIST
Credential: PT
Phone: 985-732-3549