Provider Demographics
NPI:1699857870
Name:HEALTH QUEST PHYSICAL THERAPY-PRAIRIEVILLE CLINIC, LLC
Entity Type:Organization
Organization Name:HEALTH QUEST PHYSICAL THERAPY-PRAIRIEVILLE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:225-673-4370
Mailing Address - Street 1:17534 OLD JEFFERSON HWY
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3929
Mailing Address - Country:US
Mailing Address - Phone:225-673-4370
Mailing Address - Fax:225-673-2241
Practice Address - Street 1:17534 OLD JEFFERSON HWY
Practice Address - Street 2:SUITE A-1
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3929
Practice Address - Country:US
Practice Address - Phone:225-673-4370
Practice Address - Fax:225-673-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CA61Medicare ID - Type Unspecified