Provider Demographics
NPI:1003551565
Name:OSTEOPRACTIC PHYSICAL THERAPY OF SOUTHWEST LOUISIANA LLC
Entity Type:Organization
Organization Name:OSTEOPRACTIC PHYSICAL THERAPY OF SOUTHWEST LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:936-465-6282
Mailing Address - Street 1:417 N EIGHTH ST
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648
Mailing Address - Country:US
Mailing Address - Phone:936-465-6282
Mailing Address - Fax:
Practice Address - Street 1:417 N EIGHTH ST
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648
Practice Address - Country:US
Practice Address - Phone:936-465-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty