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General NPI Number Information
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NPI Number | 1447457619
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Entity Type | Organization
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Legal Business Name | LAKESHORE PHYSICAL THERAPY CONTRACT SERVICES, LLC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 127 TCHEFUNCTA SOUTH DR
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City | COVINGTON
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State | LA
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Zip | 70433-7809
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Country | US
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Telephone | 504-874-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 127 TCHEFUNCTA SOUTH DRIVE
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 504-874-0083
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER JOSEPH CRONIN
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Credential | PT
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Telephone | 504-874-0083
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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 | 04641
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License Number State | LA
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