Provider Demographics
NPI:1154804524
Name:LANDRENEAU PHYSIOTHERAPY LLC
Entity type:Organization
Organization Name:LANDRENEAU PHYSIOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:337-450-8181
Mailing Address - Street 1:124 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5765
Mailing Address - Country:US
Mailing Address - Phone:337-450-8181
Mailing Address - Fax:
Practice Address - Street 1:508 LAFAYETTE ST STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5409
Practice Address - Country:US
Practice Address - Phone:337-450-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy