Provider Demographics
NPI:1376622365
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY CLINIC OF LAFAYETTE INC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY CLINIC OF LAFAYETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT CERT MDT
Authorized Official - Phone:337-232-5301
Mailing Address - Street 1:245 N COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4230
Mailing Address - Country:US
Mailing Address - Phone:337-232-5301
Mailing Address - Fax:337-237-6504
Practice Address - Street 1:245 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4230
Practice Address - Country:US
Practice Address - Phone:337-232-5301
Practice Address - Fax:337-237-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00497225100000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
650018362OtherRR RETIREMENT MEDICARE
23538OtherBLUE CROSS BLUE SHIELD
LA5DC76Medicare PIN