Provider Demographics
NPI:1467900654
Name:STAR PHYSICAL THERAPY NOE
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY NOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-243-6777
Mailing Address - Street 1:5931 BULLARD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2817
Mailing Address - Country:US
Mailing Address - Phone:504-243-6777
Mailing Address - Fax:504-243-6736
Practice Address - Street 1:340 FALCONER DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8204
Practice Address - Country:US
Practice Address - Phone:985-893-2845
Practice Address - Fax:985-893-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty