Healthcare Provider Details

I. General information

NPI: 1619060886
Provider Name (Legal Business Name): PHYSICIANS CHOICE PHYSICAL THERAPY OF LIVINGSTON PARISH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29419 WALKER S RD
WALKER LA
70785
US

IV. Provider business mailing address

29419 WALKER S RD
WALKER LA
70785
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-7788
  • Fax: 225-791-0095
Mailing address:
  • Phone: 225-791-7788
  • Fax: 225-791-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.200083
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3062
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01442
License Number StateLA

VIII. Authorized Official

Name: MR. TODD TRUITT JANNEY SR.
Title or Position: OWNER
Credential: PT
Phone: 225-791-7788