Provider Demographics
NPI:1073604476
Name:PHYSICAL THERAPY SOUTH, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:337-988-7777
Mailing Address - Street 1:112 REPUBLIC AVE
Mailing Address - Street 2:STE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-988-7777
Mailing Address - Fax:337-988-7720
Practice Address - Street 1:112 REPUBLIC AVE
Practice Address - Street 2:STE E
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-988-7777
Practice Address - Fax:337-988-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01644225100000X
LA02280225100000X
LA06849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X948C928Medicare ID - Type UnspecifiedMEDICARE PROVIDER#/GRP