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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