Healthcare Provider Details

I. General information

NPI: 1518911312
Provider Name (Legal Business Name): O2 PHYSICAL THERAP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W MINNESOTA PARK RD SUITE 8
HAMMOND LA
70403-6148
US

IV. Provider business mailing address

PO BOX 3210
COVINGTON LA
70434-3210
US

V. Phone/Fax

Practice location:
  • Phone: 985-340-0102
  • Fax: 985-419-0220
Mailing address:
  • Phone: 985-340-0102
  • Fax: 985-419-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1051
License Number StateLA

VIII. Authorized Official

Name: MR. DAVID MARK HEAP SR.
Title or Position: OWNER
Credential: P.T.
Phone: 985-340-0102