Healthcare Provider Details

I. General information

NPI: 1912822479
Provider Name (Legal Business Name): ROOTED MOTION PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 RIDGEFIELD RD
THIBODAUX LA
70301-2726
US

IV. Provider business mailing address

427 ROSELLA DR
THIBODAUX LA
70301-6942
US

V. Phone/Fax

Practice location:
  • Phone: 225-206-2598
  • Fax:
Mailing address:
  • Phone: 225-206-2598
  • Fax:

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: MRS. LORI W. MATHERNE
Title or Position: OWNER/PT
Credential: PT, DPT
Phone: 225-206-2598