Provider Demographics
NPI:1063473163
Name:THERAPEUTIC CONCEPTS LTD
Entity type:Organization
Organization Name:THERAPEUTIC CONCEPTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-732-3549
Mailing Address - Street 1:15126 HWY 21 S
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-7966
Mailing Address - Country:US
Mailing Address - Phone:985-732-3549
Mailing Address - Fax:985-732-3543
Practice Address - Street 1:15126 HWY 21 S
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-7966
Practice Address - Country:US
Practice Address - Phone:985-732-3549
Practice Address - Fax:985-732-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
LAPT01524R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C458Medicare ID - Type Unspecified