Provider Demographics
NPI:1770684631
Name:FELICIANA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FELICIANA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-683-1125
Mailing Address - Street 1:PO BOX 8508
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-8508
Mailing Address - Country:US
Mailing Address - Phone:225-683-1125
Mailing Address - Fax:225-683-1127
Practice Address - Street 1:12357 HAYNES ST.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-8508
Practice Address - Country:US
Practice Address - Phone:225-683-1125
Practice Address - Fax:225-683-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CW38Medicare PIN