Provider Demographics
NPI:1912417866
Name:DICHARRY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DICHARRY PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:DICHARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:225-869-9632
Mailing Address - Street 1:1959 HIGHWAY 3125 STE 1
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5641
Mailing Address - Country:US
Mailing Address - Phone:225-869-9632
Mailing Address - Fax:225-869-9633
Practice Address - Street 1:1959 HIGHWAY 3125 STE 1
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5641
Practice Address - Country:US
Practice Address - Phone:225-869-9632
Practice Address - Fax:225-869-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty