Provider Demographics
NPI:1184951964
Name:THIBODEAUX ORTHOPEDIC CLINIC, INC.
Entity type:Organization
Organization Name:THIBODEAUX ORTHOPEDIC CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-9565
Mailing Address - Street 1:525 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2627
Mailing Address - Country:US
Mailing Address - Phone:985-446-6284
Mailing Address - Fax:985-447-1754
Practice Address - Street 1:509 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2639
Practice Address - Country:US
Practice Address - Phone:985-446-9565
Practice Address - Fax:985-446-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty