Provider Demographics
NPI:1033303706
Name:PHYSICIANS' CHOICE PHYSICAL THERAPY OF IBERVILLE PARISH, L. L. C.
Entity Type:Organization
Organization Name:PHYSICIANS' CHOICE PHYSICAL THERAPY OF IBERVILLE PARISH, L. L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:TODD
Authorized Official - Middle Name:TRUITT
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:P T
Authorized Official - Phone:225-791-7788
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-0880
Mailing Address - Country:US
Mailing Address - Phone:225-791-7788
Mailing Address - Fax:225-791-0095
Practice Address - Street 1:59295 RIVER WEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6596
Practice Address - Country:US
Practice Address - Phone:225-791-7788
Practice Address - Fax:225-791-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DC03Medicare PIN