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General NPI Number Information
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NPI Number | 1518911312
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Entity Type | Organization
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Legal Business Name | O2 PHYSICAL THERAP, LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 307 W MINNESOTA PARK RD SUITE 8
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City | HAMMOND
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State | LA
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Zip | 70403-6148
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Country | US
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Telephone | 985-340-0102
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Fax | 985-419-0220
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Provider Business Mailing Address
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Address Line | PO BOX 3210
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City | COVINGTON
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State | LA
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Zip | 70434-3210
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Country | US
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Telephone | 985-340-0102
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Fax | 985-419-0220
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID MARK HEAP SR.
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Credential | P.T.
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Telephone | 985-340-0102
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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 | 1051
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License Number State | LA
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