Provider Demographics
NPI:1124138573
Name:LOUISIANA THERAPY AND WELLNESS CENTER
Entity type:Organization
Organization Name:LOUISIANA THERAPY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA, ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:985-641-3818
Mailing Address - Street 1:1601 SHORTCUT HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8047
Mailing Address - Country:US
Mailing Address - Phone:985-641-3818
Mailing Address - Fax:985-641-3891
Practice Address - Street 1:1601 SHORTCUT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8047
Practice Address - Country:US
Practice Address - Phone:985-641-3818
Practice Address - Fax:985-641-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LAA1975G225200000X
LAOTT.Z12066225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty