Provider Demographics
NPI:1740483999
Name:MORELLA PHYSICAL THERAPY CLINIC, INC
Entity type:Organization
Organization Name:MORELLA PHYSICAL THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MORELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:985-385-5172
Mailing Address - Street 1:PO BOX 3296
Mailing Address - Street 2:910 MARGUERITE STREET
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381
Mailing Address - Country:US
Mailing Address - Phone:985-385-5172
Mailing Address - Fax:
Practice Address - Street 1:910 MARGUERITE STREET
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-385-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT0390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S741Medicare PIN