Provider Demographics
NPI:1043259005
Name:CRESCENT CITY PHYSICAL THERAPY
Entity type:Organization
Organization Name:CRESCENT CITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PTP
Authorized Official - Phone:504-895-0638
Mailing Address - Street 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-895-0638
Mailing Address - Fax:504-891-5676
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-895-0638
Practice Address - Fax:504-891-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C460Medicare ID - Type UnspecifiedMEDICARE PROVIDER #