Healthcare Provider Details

I. General information

NPI: 1790749273
Provider Name (Legal Business Name): ISR PHYSICAL THERAPY OF HOUMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 RIVER OAKS RD W
HARAHAN LA
70123-2163
US

IV. Provider business mailing address

1516 RIVER OAKS RD W
HARAHAN LA
70123-2163
US

V. Phone/Fax

Practice location:
  • Phone: 504-733-2111
  • Fax: 504-733-5999
Mailing address:
  • Phone: 504-733-2111
  • Fax: 504-733-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04852
License Number StateLA

VIII. Authorized Official

Name: KAREN S. THOMAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 985-872-5911