Healthcare Provider Details

I. General information

NPI: 1104458686
Provider Name (Legal Business Name): STERLINGTON PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8649 HIGHWAY 165 N STE 5
MONROE LA
71203-8965
US

IV. Provider business mailing address

PO BOX 127
FAIRBANKS LA
71240-0127
US

V. Phone/Fax

Practice location:
  • Phone: 318-503-9789
  • Fax: 318-267-0131
Mailing address:
  • Phone: 318-503-9789
  • Fax: 318-267-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRITTNEY WHITLOCK
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 318-325-6200