Provider Demographics
NPI:1275573073
Name:REHAB DYNAMICS, LLC
Entity Type:Organization
Organization Name:REHAB DYNAMICS, LLC
Other - Org Name:REHAB DYNAMICS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-871-7878
Mailing Address - Street 1:103 NORTHPARK BLVD.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6125
Mailing Address - Country:US
Mailing Address - Phone:985-871-7878
Mailing Address - Fax:985-871-9355
Practice Address - Street 1:103 NORTHPARK BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6125
Practice Address - Country:US
Practice Address - Phone:985-871-7878
Practice Address - Fax:985-871-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA00435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X638CG50Medicare ID - Type Unspecified