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General NPI Number Information
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NPI Number | 1407961865
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Entity Type | Organization
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Legal Business Name | LOUISIANA PHYSICAL THERAPY CENTERS OF PINEVILLE LLC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1135 EXPRESSWAY DRIVE SUITE 100 B
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City | PINEVILLE
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State | LA
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Zip | 71360
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Country | US
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Telephone | 318-487-6525
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Fax | 318-487-6527
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Provider Business Mailing Address
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Address Line | P O BOX 13643
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City | ALEXANDRIA
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State | LA
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Zip | 71315
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Country | US
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Telephone | 318-487-6525
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Fax | 318-487-6527
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. KENNETH E MCKENZIE
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Credential | MPT
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Telephone | 318-487-6525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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