Provider Demographics
NPI:1174561526
Name:INZERELLA PHYSICAL THERAPY
Entity type:Organization
Organization Name:INZERELLA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:HOCUTT
Authorized Official - Last Name:INZERELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-837-4134
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-0797
Mailing Address - Country:US
Mailing Address - Phone:337-830-4134
Mailing Address - Fax:337-837-4136
Practice Address - Street 1:803 SOUTH MORGAN AVE
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518
Practice Address - Country:US
Practice Address - Phone:337-830-4134
Practice Address - Fax:337-837-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00160R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56458Medicare ID - Type Unspecified
LA5CA31Medicare ID - Type Unspecified