Provider Demographics
NPI:1225350192
Name:ST. BERNARD PHYSICAL THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:ST. BERNARD PHYSICAL THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETYE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:504-957-6722
Mailing Address - Street 1:317 W GENIE ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2127
Mailing Address - Country:US
Mailing Address - Phone:504-271-6778
Mailing Address - Fax:504-333-6770
Practice Address - Street 1:317 W GENIE ST
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-2127
Practice Address - Country:US
Practice Address - Phone:504-271-6778
Practice Address - Fax:504-333-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00112R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56346Medicare PIN