Provider Demographics
NPI:1609982750
Name:PHYSICAL THERAPY PLUS OF VERMILION, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY PLUS OF VERMILION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-893-0474
Mailing Address - Street 1:PO BOX 1552
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511
Mailing Address - Country:US
Mailing Address - Phone:337-893-0474
Mailing Address - Fax:337-740-0474
Practice Address - Street 1:524 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-6630
Practice Address - Country:US
Practice Address - Phone:337-893-0474
Practice Address - Fax:337-740-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA00758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP06Medicare PIN
LAP00265713Medicare PIN