Provider Demographics
NPI:1225402738
Name:RIVER PARISH PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:RIVER PARISH PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:PITRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-445-5785
Mailing Address - Street 1:14210 AIRLINE HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6611
Mailing Address - Country:US
Mailing Address - Phone:225-445-5785
Mailing Address - Fax:
Practice Address - Street 1:14210 AIRLINE HWY
Practice Address - Street 2:SUITE E
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6611
Practice Address - Country:US
Practice Address - Phone:225-445-5785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty