Provider Demographics
NPI:1235514142
Name:MID CITY PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:MID CITY PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:504-258-5955
Mailing Address - Street 1:4000 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6021
Mailing Address - Country:US
Mailing Address - Phone:504-301-0577
Mailing Address - Fax:
Practice Address - Street 1:4000 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6021
Practice Address - Country:US
Practice Address - Phone:504-301-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty