Provider Demographics
NPI:1861415945
Name:SOUTHERN CARE PHYSICAL THERAPY
Entity type:Organization
Organization Name:SOUTHERN CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-646-2440
Mailing Address - Street 1:1320 LAKEWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3168
Mailing Address - Country:US
Mailing Address - Phone:985-646-2440
Mailing Address - Fax:985-646-2847
Practice Address - Street 1:1320 LAKEWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3168
Practice Address - Country:US
Practice Address - Phone:985-646-2440
Practice Address - Fax:985-646-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04736R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty