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General NPI Number Information
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NPI Number | 1720034770
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Entity Type | Organization
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Legal Business Name | STAR PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 69154 HWY 190 SERV RD
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City | COVINGTON
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State | LA
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Zip | 70433-5140
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Country | US
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Telephone | 985-893-2845
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Fax | 985-893-2654
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Provider Business Mailing Address
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Address Line | 69154 HWY 190 SERV RD
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City | COVINGTON
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State | LA
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Zip | 70433-5140
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Country | US
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Telephone | 985-893-2845
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Fax | 985-893-2654
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW EDWARD SLIMMING
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Credential | P.T.
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Telephone | 985-893-2845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT 01770F
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License Number State | LA
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