Healthcare Provider Details

I. General information

NPI: 1417280959
Provider Name (Legal Business Name): PHYSICAL THERAPY INCORPORATED OF MONROE (PT INC) INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 3RD ST
MONROE LA
71201-6731
US

IV. Provider business mailing address

211 N 3RD ST
MONROE LA
71201-6731
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-4973
  • Fax: 318-322-4093
Mailing address:
  • Phone: 318-387-4973
  • Fax: 318-322-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANJELIQUE VIA LILES
Title or Position: PRESIDENT
Credential: MPT
Phone: 318-387-4973