# PREMIER PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB

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

## Provider details

- **NPI number:** 1437646767
- **Authorized official:** RUSSELL HEARNE PT,DPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (936) 465-6282

## Contact information

- **Practice address:** 243 E 1ST ST, DERIDDER, LA 70634-4105
- **Practice address phone:** (936) 465-6282
- **Mailing address:** 192 LA-3226, DERIDDER, LA 70634
- **Mailing address phone:** (936) 465-6282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 08870R | LA | — |
| 225100000X | Physical Therapist | 09007R | LA | Yes |

## Other

- **Enumeration date:** 04/23/2018
- **Last updated:** 04/23/2018