Provider Demographics
NPI:1114462694
Name:ANATOMIX PHYSICAL THERAPY-MANDEVILLE LLC
Entity Type:Organization
Organization Name:ANATOMIX PHYSICAL THERAPY-MANDEVILLE LLC
Other - Org Name:ANATOMIX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-6664
Mailing Address - Street 1:1100 C M FAGAN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5963
Mailing Address - Country:US
Mailing Address - Phone:985-542-6664
Mailing Address - Fax:985-542-6428
Practice Address - Street 1:3916 HIGHWAY 22
Practice Address - Street 2:SUITE 3
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7306
Practice Address - Country:US
Practice Address - Phone:985-542-6664
Practice Address - Fax:985-542-6428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANATOMIX PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-20
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty