Provider Demographics
NPI:1417349929
Name:NORTHEAST LOUISIANA REHABILITATION
Entity Type:Organization
Organization Name:NORTHEAST LOUISIANA REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL AND OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:SCARBOROUGH
Authorized Official - Last Name:ECKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, LOTR, PT, DPT
Authorized Official - Phone:318-620-0075
Mailing Address - Street 1:246 ALONZO RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1731
Mailing Address - Country:US
Mailing Address - Phone:318-620-0075
Mailing Address - Fax:
Practice Address - Street 1:204 BOOTS DR
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3102
Practice Address - Country:US
Practice Address - Phone:318-620-0075
Practice Address - Fax:318-620-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 261QR0400X
LAPT 08698261QP2000X
LAOTT.200620261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation