Provider Demographics
NPI:1649203787
Name:THE PHYSCIAL THERAPY CENTER
Entity Type:Organization
Organization Name:THE PHYSCIAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-201-0002
Mailing Address - Street 1:7936 OFFICE PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-201-2002
Mailing Address - Fax:225-201-0040
Practice Address - Street 1:7936 OFFICE PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-201-2002
Practice Address - Fax:225-201-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00870225X00000X
LA06302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5C802Medicare ID - Type Unspecified