Provider Demographics
NPI:1750566071
Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Entity type:Organization
Organization Name:ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAUCHEUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-654-8208
Mailing Address - Street 1:17301 JEFFERSON HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6972
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:18303 PERKINS RD E STE 407
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-3300
Practice Address - Country:US
Practice Address - Phone:225-751-8512
Practice Address - Fax:225-751-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11046225X00000X, 225X00000X
LA04423225100000X
LA00200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C943OtherMEDICARE BILLING NUMBER
5229950003Medicare NSC