Provider Demographics
NPI:1932292190
Name:PCPT OF WEST BATON ROUGE, INC
Entity Type:Organization
Organization Name:PCPT OF WEST BATON ROUGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:TRUITT
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:P T
Authorized Official - Phone:225-749-4900
Mailing Address - Street 1:402 NORTH VAUGHN
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719
Mailing Address - Country:US
Mailing Address - Phone:225-749-4900
Mailing Address - Fax:225-749-0999
Practice Address - Street 1:402 NORTH VAUGHN
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719
Practice Address - Country:US
Practice Address - Phone:225-749-4900
Practice Address - Fax:225-749-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01442225100000X
LA06477225100000X
LAOTT.200083225X00000X
LALZ12283225X00000X
LA30622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135321Medicaid
LAB9123OtherBLUECROSS OF LA
LA1135321Medicaid