Organization
VICTORY PHYSICAL THERAPY & REHAB CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AYODEJI O FAMUYIDE M.ED, P.T. (DIRECTOR)
(225) 248-0085
Entity
Organization
Contact information
Practice address
6554 FLORIDA BLVD, SUITE 119, BATON ROUGE, LA 70806-4474
(225) 248-0085
(225) 248-0086
Mailing address
PO BOX 45985, BATON ROUGE, LA 70895-4985
(225) 248-0085
(225) 248-0086
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
Other
Enumeration date
01/16/2007
Last updated
03/25/2008
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