Healthcare Provider Details

I. General information

NPI: 1538772561
Provider Name (Legal Business Name): JOSHUA KEVIN BERTHELOT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CANAL ST
NEW ORLEANS LA
70119-6535
US

IV. Provider business mailing address

1815 POPLAR ST
METAIRIE LA
70005-1044
US

V. Phone/Fax

Practice location:
  • Phone: 504-507-7079
  • Fax:
Mailing address:
  • Phone: 504-275-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08113
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number08113
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: