Provider Demographics
NPI:1790749273
Name:ISR PHYSICAL THERAPY OF HOUMA
Entity Type:Organization
Organization Name:ISR PHYSICAL THERAPY OF HOUMA
Other - Org Name:ISR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-872-5911
Mailing Address - Street 1:1516 RIVER OAKS RD W
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2163
Mailing Address - Country:US
Mailing Address - Phone:504-733-2111
Mailing Address - Fax:504-733-5999
Practice Address - Street 1:1516 RIVER OAKS RD W
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2163
Practice Address - Country:US
Practice Address - Phone:504-733-2111
Practice Address - Fax:504-733-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CC88Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER