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Organization
PREMIER PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB
Active
Organization
PREMIER PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL HEARNE PT,DPT (PHYSICAL THERAPIST)
(936) 465-6282
Entity
Organization
Contact information
Practice address
243 E 1ST ST, DERIDDER, LA 70634-4105
(936) 465-6282
Mailing address
192 LA-3226, DERIDDER, LA 70634
(936) 465-6282
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
08870R
LA
225100000X
Physical Therapist
Primary
09007R
LA
Other
Enumeration date
04/23/2018
Last updated
04/23/2018
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