# IMPACT PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407434632
- **Authorized official:** JOHN DEREK LAURENT DPT (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (504) 491-5249

## Contact information

- **Practice address:** 13702 COURSEY BLVD STE 10B, BATON ROUGE, LA 70817-1370
- **Practice address phone:** (504) 491-5249
- **Mailing address:** 13702 COURSEY BLVD STE 10B, BATON ROUGE, LA 70817-1370
- **Mailing address phone:** (504) 491-5249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2021
- **Last updated:** 10/01/2023