Provider Demographics
NPI:1235791930
Name:LAKEVIEW PHYSICAL THERAPY AND SPINE LLC
Entity Type:Organization
Organization Name:LAKEVIEW PHYSICAL THERAPY AND SPINE LLC
Other - Org Name:LAKEVIEW PHYSICAL THERAPY AND SPINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:504-343-0303
Mailing Address - Street 1:435 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1327
Mailing Address - Country:US
Mailing Address - Phone:504-343-0303
Mailing Address - Fax:
Practice Address - Street 1:7119 WEST END BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1327
Practice Address - Country:US
Practice Address - Phone:504-354-8291
Practice Address - Fax:504-354-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy