Healthcare Provider Details

I. General information

NPI: 1073530762
Provider Name (Legal Business Name): PHYSICIAN'S CHOICE PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 S RANGE AVE
DENHAM SPRINGS LA
70726-5216
US

IV. Provider business mailing address

2346 S RANGE AVE
DENHAM SPRINGS LA
70726-5216
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-8080
  • Fax: 225-665-0999
Mailing address:
  • Phone: 225-665-8080
  • Fax: 225-665-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01442
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number200083
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number3533
License Number StateLA

VIII. Authorized Official

Name: MR. TODD TRUITT JANNEY SR.
Title or Position: OWNER
Credential: PT
Phone: 225-665-8080