Provider Demographics
NPI:1417168956
Name:PHYSICIANS REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:PHYSICIANS REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-4165
Mailing Address - Street 1:700 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6910
Mailing Address - Country:US
Mailing Address - Phone:337-233-4165
Mailing Address - Fax:337-237-6729
Practice Address - Street 1:700 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6910
Practice Address - Country:US
Practice Address - Phone:337-233-4165
Practice Address - Fax:337-237-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital