Provider Demographics
NPI:1114471612
Name:PHYSICAL THERAPY CLINIC OF LAFAYETTE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CLINIC OF LAFAYETTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:337-232-7080
Mailing Address - Street 1:PO BOX 52021
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2021
Mailing Address - Country:US
Mailing Address - Phone:337-232-7080
Mailing Address - Fax:337-237-2517
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-232-7080
Practice Address - Fax:337-237-2517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY CLINIC OF LAFAYETTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-12
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00151225100000X
LA00300225100000X
LA00056225100000X
LA00521225100000X
LAZ11352225X00000X, 225XH1200X
LA1176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty