Healthcare Provider Details

I. General information

NPI: 1790809028
Provider Name (Legal Business Name): XTREME PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BEHRMAN PL
NEW ORLEANS LA
70114-8215
US

IV. Provider business mailing address

3300 BEHRMAN PL
NEW ORLEANS LA
70114-8215
US

V. Phone/Fax

Practice location:
  • Phone: 504-374-0015
  • Fax: 504-374-0016
Mailing address:
  • Phone: 504-374-0015
  • Fax: 504-374-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01248
License Number StateLA

VIII. Authorized Official

Name: MR. BRIAN KEITH SIMPSON
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 504-374-0015