1669557906 NPI number — PHYSICAL THERAPY CLINIC OF CARENCRO LLC

Table of content: JOHN EDWARD DIZON MD (NPI 1821147042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669557906 NPI number — PHYSICAL THERAPY CLINIC OF CARENCRO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CLINIC OF CARENCRO LLC
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:
6
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:
1669557906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 E SAINT PETER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARENCRO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70520-4009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-896-6686
Provider Business Mailing Address Fax Number:
337-896-8891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E SAINT PETER ST
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:
70520-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-896-6686
Provider Business Practice Location Address Fax Number:
337-896-8891
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROZAS
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
337-896-6686

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  00312 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com