Provider Demographics
NPI:1457427627
Name:PARISH PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PARISH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-735-3080
Mailing Address - Street 1:1616 S COLUMBIA ST
Mailing Address - Street 2:STE B
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427
Mailing Address - Country:US
Mailing Address - Phone:985-735-3080
Mailing Address - Fax:985-735-7031
Practice Address - Street 1:1616 S COLUMBIA ST
Practice Address - Street 2:STE B
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-5881
Practice Address - Country:US
Practice Address - Phone:985-735-3080
Practice Address - Fax:985-735-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03388261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471640Medicaid
LA5CK85Medicare PIN