Provider Demographics
NPI:1720621642
Name:EPIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EPIC PHYSICAL THERAPY, LLC
Other - Org Name:EPIC PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:DELAHOUSSAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-392-7000
Mailing Address - Street 1:102 WOODLAND HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1674
Mailing Address - Country:US
Mailing Address - Phone:504-392-7000
Mailing Address - Fax:504-584-7747
Practice Address - Street 1:102 WOODLAND HWY STE 1
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1674
Practice Address - Country:US
Practice Address - Phone:504-392-7000
Practice Address - Fax:504-584-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty