Healthcare Provider Details

I. General information

NPI: 1770684631
Provider Name (Legal Business Name): FELICIANA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12357 HAYNES ST.
CLINTON LA
70722-8508
US

IV. Provider business mailing address

PO BOX 8508
CLINTON LA
70722-8508
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-1125
  • Fax: 225-683-1127
Mailing address:
  • Phone: 225-683-1125
  • Fax: 225-683-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. BRIT JOSEPH D'AMICO
Title or Position: REGISTERED AGENT
Credential: PT
Phone: 225-683-1125