Basic Information
| Provider Information | |||||||||
| NPI: | 1699857870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH QUEST PHYSICAL THERAPY-PRAIRIEVILLE CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17534 OLD JEFFERSON HWY | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | PRAIRIEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707693929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256734370 | ||||||||
| FaxNumber: | 2256732241 | ||||||||
| Practice Location | |||||||||
| Address1: | 17534 OLD JEFFERSON HWY | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | PRAIRIEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707693929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256734370 | ||||||||
| FaxNumber: | 2256732241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MULA | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2256734370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.