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General NPI Number Information
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NPI Number | 1962424853
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 3515 HESSMER AVE
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City | METAIRIE
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State | LA
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Zip | 70002-4730
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Country | US
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Telephone | 504-885-8969
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Fax | 504-885-9190
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Provider Business Mailing Address
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Address Line | 3515 HESSMER AVE
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City | METAIRIE
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State | LA
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Zip | 70002-4730
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Country | US
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Telephone | 504-885-8969
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Fax | 504-885-9190
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. LELAND CHARLES COURET JR.
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Credential | P.T.
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Telephone | 504-885-8969
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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 | 04415
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License Number State | LA
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