Provider Demographics
NPI:1629148002
Name:ORTHOPEDIC & SPORTS THERAPY OF KENNER, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS THERAPY OF KENNER, INC.
Other - Org Name:KENNER ORTHOPEDIC & SPORTS THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-443-5152
Mailing Address - Street 1:3921 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-443-5152
Mailing Address - Fax:504-443-5151
Practice Address - Street 1:3921 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-443-5152
Practice Address - Fax:504-443-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty