Healthcare Provider Details

I. General information

NPI: 1235953035
Provider Name (Legal Business Name): MAXX THERAPY OF LAKE CHARLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 WOLF CIR
LAKE CHARLES LA
70605-2353
US

IV. Provider business mailing address

1714 WOLF CIR
LAKE CHARLES LA
70605-2353
US

V. Phone/Fax

Practice location:
  • Phone: 337-508-2505
  • Fax: 337-508-2506
Mailing address:
  • Phone: 337-508-2505
  • Fax: 337-508-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN PITRE
Title or Position: DPT
Credential:
Phone: 337-508-2505