Provider Demographics
NPI:1417280959
Name:PHYSICAL THERAPY INCORPORATED OF MONROE (PT INC) INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INCORPORATED OF MONROE (PT INC) INC
Other - Org Name:PT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJELIQUE
Authorized Official - Middle Name:VIA
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:318-387-4973
Mailing Address - Street 1:211 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6731
Mailing Address - Country:US
Mailing Address - Phone:318-387-4973
Mailing Address - Fax:318-322-4093
Practice Address - Street 1:211 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6731
Practice Address - Country:US
Practice Address - Phone:318-387-4973
Practice Address - Fax:318-322-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1012793Medicaid