Healthcare Provider Details

I. General information

NPI: 1043259005
Provider Name (Legal Business Name): CRESCENT CITY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 NAPOLEON AVE SUITE 615
NEW ORLEANS LA
70115-6357
US

IV. Provider business mailing address

2633 NAPOLEON AVE SUITE 615
NEW ORLEANS LA
70115-6357
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-0638
  • Fax: 504-891-5676
Mailing address:
  • Phone: 504-895-0638
  • Fax: 504-891-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VIRGINIA B DAVIS
Title or Position: PRESIDENT
Credential: P.TP
Phone: 504-895-0638