Provider Demographics
NPI:1043270283
Name:PHYSICAL THERAPY MASTERS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY MASTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-275-3177
Mailing Address - Street 1:11281 OLD HAMMOND HWY
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8404
Mailing Address - Country:US
Mailing Address - Phone:225-275-3177
Mailing Address - Fax:225-275-0922
Practice Address - Street 1:11281 OLD HAMMOND HWY
Practice Address - Street 2:BUILDING A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8404
Practice Address - Country:US
Practice Address - Phone:225-275-3177
Practice Address - Fax:225-275-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CB00Medicare ID - Type Unspecified