| Organization Name: | ST. JOHN PHYSICAL THERAPY, LLC |
| NPI Number: | 1225242324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DERWARD THOMAS NORSWORTHY (PHYSICAL THERAPIST) |
| Mailing Address: | 504 Rue De Sante La Place |
| State: | LA US |
| Postal Code: | 700685418 |
| Phone Number: | 9856529515 |
| Fax Number: | 9856528675 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 01/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |