Provider Demographics
NPI:1679715981
Name:INNOVATIVE SUIT THERAPY AND FITNESS, LLC
Entity type:Organization
Organization Name:INNOVATIVE SUIT THERAPY AND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:DELUCA
Authorized Official - Last Name:DELUCA GLAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-792-7700
Mailing Address - Street 1:70493 HIGHWAY 21 STE 600
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7018
Mailing Address - Country:US
Mailing Address - Phone:985-792-7700
Mailing Address - Fax:985-247-8220
Practice Address - Street 1:70493 HIGHWAY 21 STE 600
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7018
Practice Address - Country:US
Practice Address - Phone:985-792-7700
Practice Address - Fax:985-247-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04135261QP2000X
LA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy