Provider Demographics
NPI:1508857954
Name:PHYSICAL THERAPY SERVICES OF CHURCH POINT INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF CHURCH POINT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP SEC/TREASURERO-OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-6585
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-0299
Mailing Address - Country:US
Mailing Address - Phone:337-684-6585
Mailing Address - Fax:337-684-6585
Practice Address - Street 1:119 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-0119
Practice Address - Country:US
Practice Address - Phone:337-684-6585
Practice Address - Fax:337-684-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT00219261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099298OtherAETNA
2099298OtherAETNA