Healthcare Provider Details

I. General information

NPI: 1023341864
Provider Name (Legal Business Name): CHARLES KIRCHEM IV P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 LAKE FOREST BLVD. SUITE A
NEW ORLEANS LA
70127-5486
US

IV. Provider business mailing address

4324 S. SHERWOOD FOREST BLVD. SUITE B170
BATON ROUGE LA
70816
US

V. Phone/Fax

Practice location:
  • Phone: 504-245-2483
  • Fax: 985-331-1005
Mailing address:
  • Phone: 225-654-8208
  • Fax: 985-331-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number07655
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: