Provider Demographics
NPI:1316083447
Name:MAGNOLIA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MAGNOLIA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER-SCHMIT
Authorized Official - Suffix:
Authorized Official - Credentials:FAAOMPT
Authorized Official - Phone:504-733-0254
Mailing Address - Street 1:5606 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5111
Mailing Address - Country:US
Mailing Address - Phone:504-733-0254
Mailing Address - Fax:504-734-8869
Practice Address - Street 1:5606 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5111
Practice Address - Country:US
Practice Address - Phone:504-733-0254
Practice Address - Fax:504-734-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS35Medicare PIN