Provider Demographics
NPI:1548794373
Name:ENHANCE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ENHANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEQUAN
Authorized Official - Middle Name:V,
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-247-8980
Mailing Address - Street 1:3919 W AIRLINE HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5807
Mailing Address - Country:US
Mailing Address - Phone:985-247-8980
Mailing Address - Fax:877-775-9197
Practice Address - Street 1:3919 W AIRLINE HWY
Practice Address - Street 2:SUITE E
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5807
Practice Address - Country:US
Practice Address - Phone:985-247-8980
Practice Address - Fax:877-775-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty