Provider Demographics
NPI:1487063616
Name:BOURGEOIS PHYSICAL THERAPY AND SPORTS REHAB LLC
Entity type:Organization
Organization Name:BOURGEOIS PHYSICAL THERAPY AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-744-4878
Mailing Address - Street 1:17135 RONALD RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4168
Mailing Address - Country:US
Mailing Address - Phone:225-744-4878
Mailing Address - Fax:225-744-4879
Practice Address - Street 1:17135 RONALD RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4168
Practice Address - Country:US
Practice Address - Phone:225-744-4878
Practice Address - Fax:225-744-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty