Healthcare Provider Details

I. General information

NPI: 1043189863
Provider Name (Legal Business Name): PEDI PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 S POST OAK RD
SULPHUR LA
70663-3631
US

IV. Provider business mailing address

534 MARCANTEL RD
DEQUINCY LA
70633-5216
US

V. Phone/Fax

Practice location:
  • Phone: 337-884-2670
  • Fax:
Mailing address:
  • Phone: 337-884-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN BERRY GALLIEN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 337-884-2670