Provider Demographics
NPI:1316264153
Name:PHYSICAL THERAPY CLINIC OF VINTON LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CLINIC OF VINTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-589-2626
Mailing Address - Street 1:1329 A HORRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668
Mailing Address - Country:US
Mailing Address - Phone:337-589-2626
Mailing Address - Fax:337-589-2621
Practice Address - Street 1:1329A HORRIDGE ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4531
Practice Address - Country:US
Practice Address - Phone:337-589-2626
Practice Address - Fax:337-589-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT02051261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821153016OtherPERSONAL NPI