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General NPI Number Information
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NPI Number | 1619466356
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Entity Type | Organization
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Legal Business Name | SB PHYSICAL THERAPY AND SPORTS REHAB
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 12739 HIGHWAY 171 STE B
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City | LONGVILLE
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State | LA
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Zip | 70652-5050
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Country | US
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Telephone | 337-317-9290
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Fax | 337-725-4457
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Provider Business Mailing Address
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Address Line | 12739 HIGHWAY 171 STE B
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City | LONGVILLE
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State | LA
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Zip | 70652-5050
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Country | US
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Telephone | 337-317-9290
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Fax | 337-725-4457
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELODY C JACKSON
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Credential |
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Telephone | 337-317-9290
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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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