Provider Demographics
NPI:1679589915
Name:THE PHYSICAL MEDICINE CENTER, INC.
Entity type:Organization
Organization Name:THE PHYSICAL MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-5230
Mailing Address - Street 1:PO BOX 62674
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-2674
Mailing Address - Country:US
Mailing Address - Phone:337-233-5230
Mailing Address - Fax:337-233-5270
Practice Address - Street 1:401 N COLLEGE RD
Practice Address - Street 2:STE. #3 & 4
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4263
Practice Address - Country:US
Practice Address - Phone:337-233-5230
Practice Address - Fax:337-233-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE52Medicare PIN