Provider Demographics
NPI:1326136300
Name:GUILLORY'S THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:GUILLORY'S THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TOBEN
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:318-323-1110
Mailing Address - Street 1:1014 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5508
Mailing Address - Country:US
Mailing Address - Phone:318-323-1110
Mailing Address - Fax:318-323-1510
Practice Address - Street 1:1014 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5508
Practice Address - Country:US
Practice Address - Phone:318-323-1110
Practice Address - Fax:318-323-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA438358561BOtherBCBS
LA438358561BOtherBCBS