Provider Demographics
NPI:1730138835
Name:GUIDROZ PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GUIDROZ PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUIDROZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-352-9643
Mailing Address - Street 1:132 EAST FIFTH STREET
Mailing Address - Street 2:PO BOX 2002
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-352-9643
Mailing Address - Fax:318-352-9660
Practice Address - Street 1:132 EAST FIFTH STREET
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-352-9643
Practice Address - Fax:318-352-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-10-07
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
LA5CT71Medicare ID - Type Unspecified