Healthcare Provider Details

I. General information

NPI: 1093809923
Provider Name (Legal Business Name): TRITON HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax: 225-791-2891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name: BYRON NICHOLS
Title or Position: OWNER
Credential:
Phone: 225-791-8666