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Organization

CORE PHYSICAL THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MILAH MCGRAW (BUS MANAGER)
(318) 336-5400
Entity
Organization

Contact information

Practice address
4616 HIGHWAY 84 W, VIDALIA, LA 71373
(318) 336-5400
(318) 336-8621
Mailing address
4616 HIGHWAY 84 W, VIDALIA, LA 71373-3357
(318) 336-5400
(318) 336-8621

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
09009R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05702398
MS
05
236280
LA
Enumeration date
01/09/2015
Last updated
01/31/2024
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