Healthcare Provider Details

I. General information

NPI: 1083448773
Provider Name (Legal Business Name): IGNITE THERAPY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S ELM STREET
WELSH LA
70647
US

IV. Provider business mailing address

204 S ELM STREET
WELSH LA
70591
US

V. Phone/Fax

Practice location:
  • Phone: 337-370-1712
  • Fax:
Mailing address:
  • Phone: 337-370-1712
  • 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: ASHLEY GRANGER
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 337-370-1712