Provider Demographics
NPI:1124220983
Name:BOGALUSA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BOGALUSA PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-735-1426
Mailing Address - Street 1:609 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2630
Mailing Address - Country:US
Mailing Address - Phone:985-735-1426
Mailing Address - Fax:985-735-1428
Practice Address - Street 1:609 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2630
Practice Address - Country:US
Practice Address - Phone:985-735-1426
Practice Address - Fax:985-735-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty