Healthcare Provider Details

I. General information

NPI: 1750462388
Provider Name (Legal Business Name): VIVIAN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH AVE STE C
VIVIAN LA
71082-3220
US

IV. Provider business mailing address

202 SOUTH AVE STE C
VIVIAN LA
71082-3220
US

V. Phone/Fax

Practice location:
  • Phone: 318-375-5500
  • Fax: 318-375-3627
Mailing address:
  • Phone: 318-375-5500
  • Fax: 318-375-3627

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: MR. ROBERT H GATTI JR.
Title or Position: OWNER
Credential: P.T.
Phone: 318-375-5500