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General NPI Number Information
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NPI Number | 1700973054
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Entity Type | Organization
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Legal Business Name | LIFESPAN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 5108 HWY 56
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City | CHAUVIN
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State | LA
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Zip | 70344
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Country | US
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Telephone | 985-594-8332
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Fax | 985-594-8389
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Provider Business Mailing Address
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Address Line | PO BOX 58
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City | CHAUVIN
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State | LA
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Zip | 70344-0058
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Country | US
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Telephone | 985-594-8332
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Fax | 985-594-8389
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. IME E UDOM
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Credential | PT, DPT, PHD
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Telephone | 985-594-8332
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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 |
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License Number State |
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