Sb Physical Therapy And Sports Rehab | |
12739 Highway 171 Ste B, Longville, LA 70652-5050 | |
(337) 317-9290 | |
(337) 725-4457 |
Full Name | Sb Physical Therapy And Sports Rehab |
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Type | Facility |
Speciality | Physical Therapist |
Location | 12739 Highway 171 Ste B, Longville, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1619466356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | (* (Not Available)) | Primary |
Provider Name | Christopher Carl Jackson |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1972009041 PECOS PAC ID: 5799028395 Enrollment ID: I20200219002263 |
Mailing Address | Practice Location Address |
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Sb Physical Therapy And Sports Rehab 12739 Highway 171 Ste B, Longville, LA 70652-5050 Ph: (337) 317-9290 | Sb Physical Therapy And Sports Rehab 12739 Highway 171 Ste B, Longville, LA 70652-5050 Ph: (337) 317-9290 |
Randi Bullard, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 12739 Highway 171 Ste B, Longville, LA 70652 Phone: 337-317-9290 | |
Mr. Christopher Carl Jackson, PHYSICAL THERAPIST Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 12739 Highway 171 Ste B, Longville, LA 70652 Phone: 337-317-9290 Fax: 337-725-4457 |