Provider Demographics
NPI:1659640373
Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Entity Type:Organization
Organization Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Other - Org Name:MOREAU PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAUCHEUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-654-8208
Mailing Address - Street 1:4314 S SHERWOOD FOREST BLVD STE A150
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4458
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:4845 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3943
Practice Address - Country:US
Practice Address - Phone:225-286-0181
Practice Address - Fax:225-286-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C943OtherMEDICARE