Provider Demographics
NPI:1255994539
Name:FYZICAL OF BATON ROUGE, LLC
Entity type:Organization
Organization Name:FYZICAL OF BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-6900
Mailing Address - Street 1:8080 BLUEBONNET BLVD STE 2222
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7828
Mailing Address - Country:US
Mailing Address - Phone:225-408-6900
Mailing Address - Fax:225-408-6946
Practice Address - Street 1:5258 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4311
Practice Address - Country:US
Practice Address - Phone:225-408-6900
Practice Address - Fax:225-408-6946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA EAR, NOSE, THROAT AND SINUS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty