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General NPI Number Information
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NPI Number | 1568986628
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Entity Type | Organization
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Legal Business Name | REFORM PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 3304 MASONIC DR STE 4001
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City | ALEXANDRIA
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State | LA
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Zip | 71301-4255
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Country | US
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Telephone | 318-446-7355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 45
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City | BALL
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State | LA
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Zip | 71405-0045
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Country | US
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Telephone | 318-446-7355
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | JEREMIAH BIEHL
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Credential | DPT
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Telephone | 318-446-7355
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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 | 08759R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 08758R
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License Number State | LA
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