Provider Demographics
NPI:1255407193
Name:HEALTH QUEST PHYSICAL THERAPY
Entity type:Organization
Organization Name:HEALTH QUEST PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPISTS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS EDDY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:225-791-7770
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786
Mailing Address - Country:US
Mailing Address - Phone:225-275-9293
Mailing Address - Fax:225-275-7671
Practice Address - Street 1:12180 GREENWELL SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814
Practice Address - Country:US
Practice Address - Phone:225-275-9293
Practice Address - Fax:225-275-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5C580Medicare ID - Type Unspecified