NPIMap

Organization Active NPI

Impact Physical Therapy LLC

  • Physical Therapist
  • Baton Rouge, LA
National Provider Identifier
1407434632
Registry record updated Oct 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IMPACT PHYSICAL THERAPY LLC
Practice address
13702 Coursey Blvd Ste 10B
Baton Rouge, LA 70817-1370
Phone
(504) 491-5249
NPI assigned
Mar 30, 2021
Last updated
Oct 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Derek Laurent, DPTNPI 1497846448
Title
Authorized Official
Phone
(504) 491-5249

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

13702 Coursey Blvd Ste 10B
Baton Rouge, LA 70817-1370

Mailing address

13702 Coursey Blvd Ste 10B
Baton Rouge, LA 70817-1370
Phone (504) 491-5249

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210720000299 LA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2466855127 Receives reassigned benefits from 2 practitioners
Practice locations: Baton Rouge, LA

National Provider Directory

National Provider Directory

Locations

13702 Coursey Blvd
Ste 10B
Baton Rouge, LA 70817
Phone (225) 364-3915

13702 Coursey Blvd
Ste 9B
Baton Rouge, LA 70817
Phone (225) 364-3915

13702 Coursey Blvd
Ste B
Baton Rouge, LA 70817
Phone (225) 246-8000

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696118400000",
    "number": "1407434632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13702 COURSEY BLVD STE 10B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708171370",
            "telephone_number": "504-491-5249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13702 COURSEY BLVD STE 10B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708171370",
            "telephone_number": "504-491-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A",
        "authorized_official_last_name": "LAURENT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DEREK",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "504-491-5249",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.