Provider Demographics
NPI:1487839338
Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Entity Type:Organization
Organization Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Other - Org Name:MOREAU PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAUCHUEUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-654-8208
Mailing Address - Street 1:4314 S SHERWOOD FOREST BLVD STE A150
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4458
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:16309 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577
Practice Address - Country:US
Practice Address - Phone:337-585-3780
Practice Address - Fax:337-585-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 261QP2000X
LA00200225100000X
LAOTT.Z11046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C943OtherMEDICARE BILLING NUMBER