Provider Demographics
NPI:1972924041
Name:CROSS GATES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CROSS GATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-231-6480
Mailing Address - Street 1:2965 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4154
Mailing Address - Country:US
Mailing Address - Phone:985-231-6480
Mailing Address - Fax:985-231-6482
Practice Address - Street 1:2965 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4154
Practice Address - Country:US
Practice Address - Phone:985-231-6480
Practice Address - Fax:985-231-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty