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General NPI Number Information
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NPI Number | 1316290125
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Entity Type | Organization
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Legal Business Name | ST. JOHN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 1959 HIGHWAY 3125 STE 1
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City | LUTCHER
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State | LA
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Zip | 70071-5641
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Country | US
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Telephone | 225-869-9632
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Fax | 225-869-9633
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Provider Business Mailing Address
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Address Line | 1959 HIGHWAY 3125 STE 1
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City | LUTCHER
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State | LA
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Zip | 70071-5641
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Country | US
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Telephone | 225-869-9632
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Fax | 225-869-9633
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. DERWARD THOMAS NORSWORTHY JR.
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Credential | PT
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Telephone | 985-652-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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