Healthcare Provider Details

I. General information

NPI: 1407126733
Provider Name (Legal Business Name): GUIDRY PHYSICAL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70493 HIGHWAY 21 STE 600
COVINGTON LA
70433-7016
US

IV. Provider business mailing address

70493 HIGHWAY 21 STE 600
COVINGTON LA
70433-7016
US

V. Phone/Fax

Practice location:
  • Phone: 985-317-3335
  • Fax: 985-317-3327
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number07689R
License Number StateLA

VIII. Authorized Official

Name: BRENT ROBERTSON
Title or Position: OWNER/MANAGER
Credential:
Phone: 504-628-8085