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Organization
SB PHYSICAL THERAPY AND SPORTS REHAB
Active
Organization
SB PHYSICAL THERAPY AND SPORTS REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY C JACKSON (ADMINISTRATOR)
(337) 317-9290
Entity
Organization
Contact information
Practice address
12739 HIGHWAY 171 STE B, LONGVILLE, LA 70652-5050
(337) 317-9290
(337) 725-4457
Mailing address
12739 HIGHWAY 171 STE B, LONGVILLE, LA 70652-5050
(337) 317-9290
(337) 725-4457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
05/08/2018
Last updated
10/02/2023
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