# PHYSIOFIT PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PhysioFit - Destrehan, LA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760014104
- **Authorized official:** KEVIN JOHANNESON (VP REVENUE CYCLE OPERATIONS)
- **Authorized official phone:** (423) 238-7217

## Contact information

- **Practice address:** 12627 AIRLINE HWY STE A, DESTREHAN, LA 70047-2550
- **Practice address phone:** (985) 603-4157
- **Practice address fax:** (985) 603-4242
- **Mailing address:** 6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-4915
- **Mailing address phone:** (423) 238-7217
- **Mailing address fax:** (423) 238-3473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 02/04/2020
- **Last updated:** 02/27/2020