Healthcare Provider Details

I. General information

NPI: 1225242324
Provider Name (Legal Business Name): ST. JOHN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 RUE DE SANTE
LA PLACE LA
70068-5418
US

IV. Provider business mailing address

504 RUE DE SANTE
LA PLACE LA
70068-5418
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-9515
  • Fax: 985-652-8675
Mailing address:
  • Phone: 985-652-9515
  • Fax: 985-652-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DERWARD THOMAS NORSWORTHY
Title or Position: PHYSICAL THERAPIST
Credential: PHYSICAL THERAPIST
Phone: 985-652-9515