Healthcare Provider Details

I. General information

NPI: 1932284635
Provider Name (Legal Business Name): LOUISIANA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 I-49 SOUTH SERVICE ROAD
OPELOUSAS LA
70570
US

IV. Provider business mailing address

420 W PINHOOK RD SUITE A
LAFAYETTE LA
70503-2131
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4214
  • Fax: 337-942-9979
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH G. MYERS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 337-233-1307