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General NPI Number Information
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NPI Number | 1609243716
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Entity Type | Organization
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Legal Business Name | CORE PHYSICAL THERAPY AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 460 ASHLEY RIDGE BLVD STE 800
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City | SHREVEPORT
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State | LA
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Zip | 71106-7238
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Country | US
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Telephone | 318-868-6172
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Fax | 318-868-6173
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Provider Business Mailing Address
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Address Line | PO BOX 53614
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City | LAFAYETTE
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State | LA
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Zip | 70505-3614
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Country | US
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Telephone | 337-233-7977
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Fax | 337-233-7978
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Authorized Official
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Title or Position | PT/CO-PWNER
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Name | MR. BRENNAN BERNARD
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Credential |
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Telephone | 318-868-6172
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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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