Healthcare Provider Details

I. General information

NPI: 1033368261
Provider Name (Legal Business Name): COVINGTON PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19345 SUNSHINE AVE
COVINGTON LA
70433-8834
US

IV. Provider business mailing address

19345 SUNSHINE AVE
COVINGTON LA
70433-8834
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-8875
  • Fax: 985-893-3381
Mailing address:
  • Phone: 985-893-8875
  • Fax: 985-893-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL P HEBERT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 985-893-8875