Provider Demographics
NPI:1376751263
Name:GREATER BATON ROUGE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GREATER BATON ROUGE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AREWANDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:225-454-6005
Mailing Address - Street 1:7855 HOWELL BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:225-454-6005
Mailing Address - Fax:225-454-6018
Practice Address - Street 1:7855 HOWELL BLVD
Practice Address - Street 2:220
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:225-454-6005
Practice Address - Fax:225-454-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty