Healthcare Provider Details

I. General information

NPI: 1144348723
Provider Name (Legal Business Name): THE THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 PARK AVE
HOUMA LA
70364
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-5322
  • Fax:
Mailing address:
  • Phone: 502-596-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. TERRANCE K. DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220