1639942584 NPI number — ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82

Table of content: (NPI 1639942584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639942584 NPI number — ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVIN C MOREAU JR LICENSED PHYSICAL THERAPIST DTD 01 15 82
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639942584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4314 S SHERWOOD FOREST BLVD STE A150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-654-8208
Provider Business Mailing Address Fax Number:
225-465-8823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730 NE EVANGELINE TRWY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARENCRO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70520-5984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-469-3003
Provider Business Practice Location Address Fax Number:
337-485-5901
Provider Enumeration Date:
11/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FAUCHEUX
Authorized Official First Name:
CRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
225-654-8208

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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