Provider Demographics
NPI:1235537168
Name:ANACOCO BAYOU PHYSICAL REHAB
Entity Type:Organization
Organization Name:ANACOCO BAYOU PHYSICAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:I
Authorized Official - Credentials:BS
Authorized Official - Phone:337-224-3471
Mailing Address - Street 1:154 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ANACOCO
Mailing Address - State:LA
Mailing Address - Zip Code:71403-3158
Mailing Address - Country:US
Mailing Address - Phone:337-224-3471
Mailing Address - Fax:
Practice Address - Street 1:154 E LAKE DR
Practice Address - Street 2:
Practice Address - City:ANACOCO
Practice Address - State:LA
Practice Address - Zip Code:71403-3158
Practice Address - Country:US
Practice Address - Phone:337-224-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01612261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy