Provider Demographics
NPI:1215028618
Name:PHYSICAL THERAPY OF BATON ROUGE, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF BATON ROUGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-751-3696
Mailing Address - Street 1:2645 ONEAL LANE BLDG C
Mailing Address - Street 2:STE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3179
Mailing Address - Country:US
Mailing Address - Phone:225-751-3696
Mailing Address - Fax:225-751-3697
Practice Address - Street 1:2645 ONEAL LANE BLDG C
Practice Address - Street 2:STE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3179
Practice Address - Country:US
Practice Address - Phone:225-751-3696
Practice Address - Fax:225-751-3697
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
LA01455F225100000X
LA00619225100000X
LA00356225100000X
LA02040F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF6968OtherBLUE CROSS OF
LA4B532C746Medicare ID - Type UnspecifiedMEDICARE PROVIDER #/GRP
LAF6968OtherBLUE CROSS OF
LA4C830C746Medicare ID - Type UnspecifiedMEDICARE PROVIDER#/GRP