Provider Demographics
NPI:1750332987
Name:TRI-STATE PHYSICAL THERAPY #4 INC
Entity Type:Organization
Organization Name:TRI-STATE PHYSICAL THERAPY #4 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-631-7999
Mailing Address - Street 1:2820 HEARNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3934
Mailing Address - Country:US
Mailing Address - Phone:318-631-7999
Mailing Address - Fax:318-631-9528
Practice Address - Street 1:2250 HOSPITAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2167
Practice Address - Country:US
Practice Address - Phone:318-747-1760
Practice Address - Fax:318-742-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACH7224Medicare ID - Type UnspecifiedRAILROAD
LA5C698Medicare ID - Type Unspecified