Provider Demographics
NPI:1326175217
Name:CALCASIEU REHAB & SPORTS THERAPY
Entity Type:Organization
Organization Name:CALCASIEU REHAB & SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-310-5116
Mailing Address - Street 1:2100 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7864
Mailing Address - Country:US
Mailing Address - Phone:337-310-5116
Mailing Address - Fax:337-310-5118
Practice Address - Street 1:2100 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7864
Practice Address - Country:US
Practice Address - Phone:337-310-5116
Practice Address - Fax:337-310-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy