Healthcare Provider Details

I. General information

NPI: 1003551565
Provider Name (Legal Business Name): OSTEOPRACTIC PHYSICAL THERAPY OF SOUTHWEST LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 HORRIDGE ST
VINTON LA
70668-4531
US

IV. Provider business mailing address

1329 HORRIDGE ST
VINTON LA
70668-4531
US

V. Phone/Fax

Practice location:
  • Phone: 337-735-3930
  • Fax: 337-391-2839
Mailing address:
  • Phone: 337-735-3930
  • Fax: 337-391-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUSSELL WARREN HEARNE
Title or Position: CO-OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 337-735-3930