Provider Demographics
NPI:1720382609
Name:PHYSICIANS CHOICE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:T
Authorized Official - Last Name:JANNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT-01442
Authorized Official - Phone:225-791-7788
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-0880
Mailing Address - Country:US
Mailing Address - Phone:225-791-7788
Mailing Address - Fax:225-791-3938
Practice Address - Street 1:29419 WALKER RD S
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7905
Practice Address - Country:US
Practice Address - Phone:225-791-7788
Practice Address - Fax:225-791-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01442261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1693715Medicaid
LA19-6603OtherMEDICARE A