Provider Demographics
NPI:1235145780
Name:BATON ROUGE PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:BATON ROUGE PHYSICAL MEDICINE
Other - Org Name:BATON ROUGE PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:UTRERA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:225-924-2555
Mailing Address - Street 1:8149 FLORIDA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4722
Mailing Address - Country:US
Mailing Address - Phone:225-924-2555
Mailing Address - Fax:225-927-0404
Practice Address - Street 1:8149 FLORIDA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4722
Practice Address - Country:US
Practice Address - Phone:225-924-2555
Practice Address - Fax:225-927-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB61634Medicare PIN