Provider Demographics
NPI:1770274615
Name:THE DIZZY PT CONCIERGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:THE DIZZY PT CONCIERGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-993-1220
Mailing Address - Street 1:7718 DON BUDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1710
Mailing Address - Country:US
Mailing Address - Phone:255-431-8289
Mailing Address - Fax:225-416-6051
Practice Address - Street 1:7718 DON BUDGE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1710
Practice Address - Country:US
Practice Address - Phone:255-431-8289
Practice Address - Fax:225-416-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation