Provider Demographics
NPI:1073530762
Name:PHYSICIAN'S CHOICE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:PHYSICIAN'S CHOICE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:TRUITT
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:225-665-8080
Mailing Address - Street 1:2346 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5216
Mailing Address - Country:US
Mailing Address - Phone:225-665-8080
Mailing Address - Fax:225-665-0999
Practice Address - Street 1:2346 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5216
Practice Address - Country:US
Practice Address - Phone:225-665-8080
Practice Address - Fax:225-665-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01442225100000X
LA200083225X00000X
LA3533235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1693715Medicaid
LA5953720001Medicare NSC
LA1693715Medicaid