=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639371545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENT PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2735 CULPEPPER RD SUITE B AND C
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-201-9282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8424 RIDGEMONT DR
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-201-9282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES H KENT
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 318-201-9282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 04299R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------