Healthcare Provider Details

I. General information

NPI: 1700446846
Provider Name (Legal Business Name): UNLOCK PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 AMBASSADOR CAFFERY PKWY STE 500
LAFAYETTE LA
70503-5266
US

IV. Provider business mailing address

3810 AMBASSADOR CAFFERY PKWY STE 500
LAFAYETTE LA
70503-5266
US

V. Phone/Fax

Practice location:
  • Phone: 337-224-1724
  • Fax:
Mailing address:
  • Phone: 337-484-3056
  • Fax: 337-484-3087

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: KERRY JAMES LAMKIN
Title or Position: PRESIDENT/MANAGING MEMBER
Credential: MS,PT
Phone: 337-484-3056