Provider Demographics
NPI:1750462388
Name:VIVIAN PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:VIVIAN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GATTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:318-375-5500
Mailing Address - Street 1:202 SOUTH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3220
Mailing Address - Country:US
Mailing Address - Phone:318-375-5500
Mailing Address - Fax:318-375-3627
Practice Address - Street 1:202 SOUTH AVE STE C
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3220
Practice Address - Country:US
Practice Address - Phone:318-375-5500
Practice Address - Fax:318-375-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1989878Medicaid
LA1989878Medicaid