Provider Demographics
NPI:1760022701
Name:WESTLAKE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WESTLAKE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:337-405-9379
Mailing Address - Street 1:1756 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8199
Mailing Address - Country:US
Mailing Address - Phone:337-405-9379
Mailing Address - Fax:
Practice Address - Street 1:1756 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-8199
Practice Address - Country:US
Practice Address - Phone:337-405-9379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty