Provider Demographics
NPI:1619060886
Name:PHYSICIANS CHOICE PHYSICAL THERAPY OF LIVINGSTON PARISH INC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE PHYSICAL THERAPY OF LIVINGSTON PARISH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:TRUITT
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:225-791-7788
Mailing Address - Street 1:29419 WALKER S RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785
Mailing Address - Country:US
Mailing Address - Phone:225-791-7788
Mailing Address - Fax:225-791-0095
Practice Address - Street 1:29419 WALKER S RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-791-7788
Practice Address - Fax:225-791-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01442225100000X
LAOTT.200083225X00000X
LA30622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437118140BOtherBLUECROSS OF LA PROVIDER
LA437118140BOtherBLUECROSS OF LA PROVIDER