Provider Demographics
NPI:1982039095
Name:PRO PHYSICAL THERAPY OF COVINGTON, LLC
Entity Type:Organization
Organization Name:PRO PHYSICAL THERAPY OF COVINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:504-912-3501
Mailing Address - Street 1:15784 MEDICAL ARTS PLAZA DR.
Mailing Address - Street 2:STE. A
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-542-9441
Mailing Address - Fax:985-542-9414
Practice Address - Street 1:720 WEST 21ST AVENUE
Practice Address - Street 2:STE. B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-912-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08610R261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy