Provider Demographics
NPI:1407829252
Name:RIVER REGION REHAB, LLC
Entity Type:Organization
Organization Name:RIVER REGION REHAB, LLC
Other - Org Name:PT SOLUTIONS OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-981-3543
Mailing Address - Street 1:12371 HIGHWAY 90
Mailing Address - Street 2:SUITE D
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-5125
Mailing Address - Country:US
Mailing Address - Phone:985-331-1001
Mailing Address - Fax:985-331-1005
Practice Address - Street 1:12371 HIGHWAY 90
Practice Address - Street 2:SUITE D
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-5125
Practice Address - Country:US
Practice Address - Phone:985-331-1001
Practice Address - Fax:985-331-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD46Medicare ID - Type Unspecified