MEDICARE: CORE PHYSICAL THERAPY & SPORTS PERFORMANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT04181	LA

General Provider Information

NPI Number	:	1417437443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE PHYSICAL THERAPY & SPORTS PERFORMANCE LLC

Provider Business Mailing Address
First Line	:	1340 ELM ST STE 101
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1893
Country	:	US
Telephone Number	:	985-384-1999
Fax Number	:	985-384-1998

Provider Business Practice Location Address
First Line	:	1340 ELM ST STE 101
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1893
Country	:	US
Telephone Number	:	985-384-1999
Fax Number	:	985-384-1998

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. CHET CHRISTOPHER STERNFELS
Credential	:	DPT
Telephone Number	:	985-384-1999

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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