Healthcare Provider Details

I. General information

NPI: 1033259486
Provider Name (Legal Business Name): ASCENSION PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CLINIC DR
DONALDSONVILLE LA
70346
US

IV. Provider business mailing address

204 CLINIC DR
DONALDSONVILLE LA
70346
US

V. Phone/Fax

Practice location:
  • Phone: 225-473-4719
  • Fax: 225-473-4719
Mailing address:
  • Phone: 225-473-4719
  • Fax: 225-473-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JERRY W PAIGE
Title or Position: OWNER LICENSED PHYSICAL THERAPIST
Credential:
Phone: 225-473-4719