Provider Demographics
NPI:1740907310
Name:QUAD C PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:QUAD C PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEARSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:318-256-0660
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-0127
Mailing Address - Country:US
Mailing Address - Phone:318-256-0660
Mailing Address - Fax:318-256-0661
Practice Address - Street 1:9058 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-1812
Practice Address - Country:US
Practice Address - Phone:318-256-0660
Practice Address - Fax:318-256-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy