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General NPI Number Information
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NPI Number | 1801157052
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Entity Type | Organization
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Legal Business Name | TRIUMPH REHABILITATION AND SPORTS THERAPY CLINIC, LLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 350 DESIARD PLAZA DR
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City | MONROE
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State | LA
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Zip | 71203-4959
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Country | US
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Telephone | 318-343-1870
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Fax | 318-345-2862
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Provider Business Mailing Address
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Address Line | PO BOX 9144
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City | MONROE
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State | LA
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Zip | 71211-9144
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Country | US
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Telephone | 318-343-1870
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Fax | 318-345-2862
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Authorized Official
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Title or Position | OWNER
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Name | MR. VERNON MOSS
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Credential | OT
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Telephone | 318-343-1870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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