Provider Demographics
NPI:1801446802
Name:ETHOS HUMAN PERFORMANCE & PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ETHOS HUMAN PERFORMANCE & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:V
Authorized Official - Last Name:OCEGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:559-361-0484
Mailing Address - Street 1:10440 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3203
Mailing Address - Country:US
Mailing Address - Phone:559-361-0484
Mailing Address - Fax:
Practice Address - Street 1:10440 HOOPER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3203
Practice Address - Country:US
Practice Address - Phone:559-361-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty