Provider Demographics
NPI:1366505299
Name:THIBODAUX PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:THIBODAUX PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-446-3736
Mailing Address - Street 1:104 E BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3036
Mailing Address - Country:US
Mailing Address - Phone:985-446-3736
Mailing Address - Fax:985-446-3701
Practice Address - Street 1:104 E BAYOU RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3036
Practice Address - Country:US
Practice Address - Phone:985-446-3736
Practice Address - Fax:985-446-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00299261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD96Medicare ID - Type Unspecified