Provider Demographics
NPI:1588315055
Name:POST TRAUMA INSTITUTE OF LOUISIANA
Entity type:Organization
Organization Name:POST TRAUMA INSTITUTE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:SALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-361-8225
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:DUPLESSIS
Mailing Address - State:LA
Mailing Address - Zip Code:70728-0375
Mailing Address - Country:US
Mailing Address - Phone:225-361-8225
Mailing Address - Fax:225-751-5847
Practice Address - Street 1:4475 S I 19 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-6335
Practice Address - Country:US
Practice Address - Phone:225-361-8225
Practice Address - Fax:225-751-5847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POST TRAUMA INSTITUTE OF LOUISIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty