# SB PHYSICAL THERAPY AND SPORTS REHAB

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

## Provider details

- **NPI number:** 1619466356
- **Authorized official:** MELODY C JACKSON (ADMINISTRATOR)
- **Authorized official phone:** (337) 317-9290

## Contact information

- **Practice address:** 12739 HIGHWAY 171 STE B, LONGVILLE, LA 70652-5050
- **Practice address phone:** (337) 317-9290
- **Practice address fax:** (337) 725-4457
- **Mailing address:** 12739 HIGHWAY 171 STE B, LONGVILLE, LA 70652-5050
- **Mailing address phone:** (337) 317-9290
- **Mailing address fax:** (337) 725-4457

## Taxonomy

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

## Other

- **Enumeration date:** 05/08/2018
- **Last updated:** 10/02/2023