Provider Demographics
NPI:1053361840
Name:SELECT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SELECT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-769-9203
Mailing Address - Street 1:7932 SUMMA AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3416
Mailing Address - Country:US
Mailing Address - Phone:225-769-9203
Mailing Address - Fax:225-769-9205
Practice Address - Street 1:7932 SUMMA AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3416
Practice Address - Country:US
Practice Address - Phone:225-769-9203
Practice Address - Fax:225-769-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH0011OtherBCBS OF LOUISIANA
LA5CP45Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER