Provider Demographics
NPI:1871543918
Name:TRI CITY PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:TRI CITY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-991-9972
Mailing Address - Street 1:PO BOX 80965
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0965
Mailing Address - Country:US
Mailing Address - Phone:337-991-9972
Mailing Address - Fax:337-991-9974
Practice Address - Street 1:233 DOUCET RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3403
Practice Address - Country:US
Practice Address - Phone:337-991-9972
Practice Address - Fax:337-991-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-07-11
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
LAF6273OtherBCBS OF LOUISIANA
LAF6273OtherBCBS OF LOUISIANA