Provider Demographics
NPI:1326360074
Name:MC2 ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MC2 ENTERPRISES, LLC
Other - Org Name:GO PHYSICAL THERAPY - MANSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-456-4419
Mailing Address - Street 1:4715 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3040
Mailing Address - Country:US
Mailing Address - Phone:225-456-4419
Mailing Address - Fax:225-923-0111
Practice Address - Street 1:8100 YMCA PLAZA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0916
Practice Address - Country:US
Practice Address - Phone:225-456-4419
Practice Address - Fax:225-923-0111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MC2 ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy