Provider Demographics
NPI:1962624353
Name:BACK-UP THERAPY SERVICES, INC
Entity type:Organization
Organization Name:BACK-UP THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:225-939-0228
Mailing Address - Street 1:430 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535
Mailing Address - Country:US
Mailing Address - Phone:225-939-0228
Mailing Address - Fax:
Practice Address - Street 1:430 S 12TH ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535
Practice Address - Country:US
Practice Address - Phone:225-939-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00594261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy