Provider Demographics
NPI:1346531332
Name:SPINE AND BODY LLC
Entity Type:Organization
Organization Name:SPINE AND BODY LLC
Other - Org Name:SPINE AND BODY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-397-3788
Mailing Address - Street 1:18306 FOUNTAIN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3053
Mailing Address - Country:US
Mailing Address - Phone:985-397-3788
Mailing Address - Fax:225-673-3286
Practice Address - Street 1:8460 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2823
Practice Address - Country:US
Practice Address - Phone:985-397-3788
Practice Address - Fax:225-673-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04772F225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty