Provider Demographics
NPI:1003834706
Name:CHRISTIE THERAPY CENTER, INC.
Entity type:Organization
Organization Name:CHRISTIE THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BUILLARD
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-981-9940
Mailing Address - Street 1:312 GUILBEAU RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6952
Mailing Address - Country:US
Mailing Address - Phone:337-981-9940
Mailing Address - Fax:337-981-2531
Practice Address - Street 1:312 GUILBEAU RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6952
Practice Address - Country:US
Practice Address - Phone:337-981-9940
Practice Address - Fax:337-981-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA965103TC0700X
LA03172225100000X
LAOTT.Z10814225X00000X
LA4559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS84Medicare ID - Type Unspecified