Bourgeois Physical Therapy and Sports Rehab LLC
Organization Active NPI Physical Therapist · Prairieville, LA
NPI 1487063616 · NPPES record last updated Feb 3, 2015
Key facts
- NPI
- 1487063616
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- BOURGEOIS PHYSICAL THERAPY AND SPORTS REHAB LLC
- Practice address
- 17135 Ronald Rd
Prairieville, LA 70769-4168 - Phone
- (225) 744-4878
- Fax
- (225) 744-4879
- NPI assigned
- Aug 13, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Christian Benedict Bourgeois, PT
- Title
- Physical Therapist/Owner
- Phone
- (225) 744-4878
Practitioners 8
-
Brooke Constant, PT, DPT
-
Michaela McInnis, DPT
-
Jason M Schexnayder, PT, DPT
-
Kishan Shah, PT
-
Devin Speligene, DPT
-
Kasey Moore Ware, P.T., DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150304000586 | LA | Part B Supplier - Clinic/Group Practice | 8820314115 |
Receives reassigned benefits from 8 practitioners Practice locations: Gonzales, LA; Prairieville, LA |
National Provider Directory
Locations
2733 W Outfitters Dr
Gonzales, LA 70737
Phone (225) 255-4040
17135 Ronald Rd
Ste B
Prairieville, LA 70769
17135 Ronald Rd
Prairieville, LA 70769
Phone (225) 744-4878
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
17135 Ronald Rd
Prairieville, LA 70769-4168
Mailing address
17135 Ronald Rd
Prairieville, LA 70769-4168
Phone (225) 744-4878
Other providers in Prairieville, LA
- Charleese Boatmon
- Krysta Danee' Boatner
- Victoria Michel Boesen
- Sundiata Bondojia
- Aleshia A Borskey
- Breanne Bourgeois
- Christian B Bourgeois
- Shelby Lynn Bourgeois
- Patrick W. Bourque
- Karsyn McCall Bowen
All providers in Prairieville, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.