Provider Demographics
NPI:1689074437
Name:PHYSICAL THERAPY SOUTH INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-451-6385
Mailing Address - Street 1:810 S SAINT BLAISE LN
Mailing Address - Street 2:STE A
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5581
Mailing Address - Country:US
Mailing Address - Phone:337-451-6385
Mailing Address - Fax:337-451-6708
Practice Address - Street 1:810 S SAINT BLAISE LN
Practice Address - Street 2:STE A
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5581
Practice Address - Country:US
Practice Address - Phone:337-451-6385
Practice Address - Fax:337-451-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C928OtherMEDICARE PTAN