Provider Demographics
NPI:1386010213
Name:MEDICAL REHAB ACCIDENT INJURY CENTER OF GENTILLY,LLC
Entity Type:Organization
Organization Name:MEDICAL REHAB ACCIDENT INJURY CENTER OF GENTILLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-304-5151
Mailing Address - Street 1:1995 GENTILLY BLVD
Mailing Address - Street 2:C-14
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-1700
Mailing Address - Country:US
Mailing Address - Phone:504-304-5151
Mailing Address - Fax:504-702-5994
Practice Address - Street 1:1995 GENTILLY BLVD
Practice Address - Street 2:C-14
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-1700
Practice Address - Country:US
Practice Address - Phone:504-304-5151
Practice Address - Fax:504-702-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1041111N00000X
LA024904208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty