Healthcare Provider Details

I. General information

NPI: 1447452974
Provider Name (Legal Business Name): PIERRE PART PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 LEE DR
PIERRE PART LA
70339-4935
US

IV. Provider business mailing address

2729 LEE DR
PIERRE PART LA
70339-4935
US

V. Phone/Fax

Practice location:
  • Phone: 985-252-9396
  • Fax: 985-252-9396
Mailing address:
  • Phone: 985-252-9396
  • Fax: 985-252-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00280
License Number StateLA

VIII. Authorized Official

Name: JENNY PAINE
Title or Position: OWNER
Credential: PT
Phone: 985-252-9396