Provider Demographics
NPI:1447529490
Name:INTEGRATED PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:SORREL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:337-380-2823
Mailing Address - Street 1:218 RUE LOUIS XIV
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5766
Mailing Address - Country:US
Mailing Address - Phone:337-456-6148
Mailing Address - Fax:337-456-6239
Practice Address - Street 1:218 RUE LOUIS XIV
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5766
Practice Address - Country:US
Practice Address - Phone:337-456-6148
Practice Address - Fax:337-456-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy