Healthcare Provider Details

I. General information

NPI: 1326419177
Provider Name (Legal Business Name): DESOTO PHYSICAL THERAPY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 08/18/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PLANTATION HILLS BLVD
STONEWALL LA
71078-9415
US

IV. Provider business mailing address

318 PLANTATION HILLS BLVD
STONEWALL LA
71078
US

V. Phone/Fax

Practice location:
  • Phone: 318-775-9870
  • Fax: 318-775-9884
Mailing address:
  • Phone: 318-775-9870
  • Fax: 318-775-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number08023
License Number StateLA

VIII. Authorized Official

Name: WILLIAM DOUGLAS JAMES
Title or Position: OWNER
Credential:
Phone: 318-775-9870