Healthcare Provider Details

I. General information

NPI: 1841569563
Provider Name (Legal Business Name): ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 I 49 S SERVICE RD
OPELOUSAS LA
70570-0757
US

IV. Provider business mailing address

4314 S SHERWOOD FOREST BLVD STE A150
BATON ROUGE LA
70816-4458
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4212
  • Fax: 337-942-9979
Mailing address:
  • Phone: 225-654-8208
  • Fax: 225-465-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA M FAUCHEUX
Title or Position: VICE PRESIDENT
Credential: PT
Phone: 225-654-8208