Healthcare Provider Details

I. General information

NPI: 1114471612
Provider Name (Legal Business Name): PHYSICAL THERAPY CLINIC OF LAFAYETTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-8800
US

IV. Provider business mailing address

PO BOX 52021
LAFAYETTE LA
70505-2021
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-7080
  • Fax: 337-237-2517
Mailing address:
  • Phone: 337-232-7080
  • Fax: 337-237-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00151
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00056
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00521
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11352
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberZ11352
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1176
License Number StateLA
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00300
License Number StateLA

VIII. Authorized Official

Name: MR. CHRISTOPHER J BARRAS SR.
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 337-232-7080