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General NPI Number Information
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NPI Number | 1831962018
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Entity Type | Organization
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Legal Business Name | ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 6438 PHELAN BLVD
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City | BEAUMONT
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State | TX
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Zip | 77706-6047
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Country | US
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Telephone | 409-203-4380
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Fax | 409-269-2031
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Provider Business Mailing Address
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Address Line | 4314 S SHERWOOD FOREST BLVD STE A150
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City | BATON ROUGE
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State | LA
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Zip | 70816-4458
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Country | US
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Telephone | 225-654-8208
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Fax | 225-465-8823
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CRISTINA M FAUCHEUX
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Credential | PT
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Telephone | 225-654-8208
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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