Provider Demographics
NPI:1518911312
Name:O2 PHYSICAL THERAP, LLC
Entity Type:Organization
Organization Name:O2 PHYSICAL THERAP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HEAP
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:985-340-0102
Mailing Address - Street 1:PO BOX 3210
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-3210
Mailing Address - Country:US
Mailing Address - Phone:985-340-0102
Mailing Address - Fax:985-419-0220
Practice Address - Street 1:307 W MINNESOTA PARK RD
Practice Address - Street 2:SUITE 8
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6148
Practice Address - Country:US
Practice Address - Phone:985-340-0102
Practice Address - Fax:985-419-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1051261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP01Medicare PIN