Provider Demographics
NPI:1114585130
Name:CLOUGHLEY, WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CLOUGHLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 HOSPITAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-2633
Mailing Address - Country:US
Mailing Address - Phone:225-638-4455
Mailing Address - Fax:225-208-6172
Practice Address - Street 1:1160 HOSPITAL RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2633
Practice Address - Country:US
Practice Address - Phone:225-638-4455
Practice Address - Fax:225-208-6172
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02225R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02225ROtherPHYSICAL THERAPY LICENSE