Organization
BAKER PHYSICAL THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JULIAN CRAIG MCCULLOCH P.T. (OWNER)
(225) 775-7051
Entity
Organization
Contact information
Practice address
4971 GROOM RD, BAKER, LA 70714-3145
(225) 775-7051
(225) 774-7244
Mailing address
4971 GROOM RD, BAKER, LA 70714-3145
(225) 775-7051
(225) 774-7244
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
PT-0307
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23651
BLUE CROSS PROVIDER #
LA
Enumeration date
02/21/2007
Last updated
06/21/2018
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