Basic Information
| Provider Information | |||||||||
| NPI: | 1841569563 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82 | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LEBLANC CHAMBERLAIN AND MARTIN/ MOREAU PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 CHURCH ST | ||||||||
| Address2: | SUITE G | ||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707912700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256548208 | ||||||||
| FaxNumber: | 2256544642 | ||||||||
| Practice Location | |||||||||
| Address1: | 4027 I 49 S SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705700757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379484212 | ||||||||
| FaxNumber: | 3379429979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2011 | ||||||||
| LastUpdateDate: | 02/23/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOREAU | ||||||||
| AuthorizedOfficialFirstName: | ALVIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2256548208 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5C943 | 01 | LA | MEDICARE | OTHER |