Provider Demographics
NPI:1396209151
Name:EPIPHANY PHYSIO HEALTH, LLC
Entity Type:Organization
Organization Name:EPIPHANY PHYSIO HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-400-0515
Mailing Address - Street 1:3321 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3680
Mailing Address - Country:US
Mailing Address - Phone:504-400-0515
Mailing Address - Fax:
Practice Address - Street 1:3321 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3680
Practice Address - Country:US
Practice Address - Phone:504-400-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy