=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720031222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPIDES PHYSICAL THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 4TH ST BOX 30112
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-4455
-----------------------------------------------------
Fax | 318-445-5574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 4TH ST BOX 30112
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-4455
-----------------------------------------------------
Fax | 318-445-5574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PRESIDENT
-----------------------------------------------------
Name | SAMUEL THOMAS FORESTER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 318-445-4455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 04559
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------