Provider Demographics
NPI:1255381976
Name:NORTHEAST LOUISIANA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:NORTHEAST LOUISIANA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-728-3665
Mailing Address - Street 1:161 CHRISTIAN DR
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3658
Mailing Address - Country:US
Mailing Address - Phone:318-728-3665
Mailing Address - Fax:318-728-3625
Practice Address - Street 1:161 CHRISTIAN DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3658
Practice Address - Country:US
Practice Address - Phone:318-728-3665
Practice Address - Fax:318-728-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9390OtherBCBS PROVIDER NUMBER
LAG9390OtherBCBS PROVIDER NUMBER