Provider Demographics
NPI:1154471498
Name:PHYSICAL THERAPY ASSOCIATES OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF LOUISIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-477-8823
Mailing Address - Street 1:611 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1521
Mailing Address - Country:US
Mailing Address - Phone:337-477-8823
Mailing Address - Fax:337-477-0143
Practice Address - Street 1:611 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1521
Practice Address - Country:US
Practice Address - Phone:337-477-8823
Practice Address - Fax:337-477-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty