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General NPI Number Information
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NPI Number | 1407126733
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Entity Type | Organization
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Legal Business Name | GUIDRY PHYSICAL THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 70493 HIGHWAY 21 STE 600
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City | COVINGTON
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State | LA
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Zip | 70433-7016
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Country | US
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Telephone | 985-317-3335
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Fax | 985-317-3327
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Provider Business Mailing Address
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Address Line | 70493 HIGHWAY 21 STE 600
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City | COVINGTON
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State | LA
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Zip | 70433-7016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | BRENT ROBERTSON
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Credential |
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Telephone | 504-628-8085
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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 | 07689R
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License Number State | LA
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