Provider Demographics
NPI:1427230267
Name:ACADIANA REHAB ASSOCIATES INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ACADIANA REHAB ASSOCIATES INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-0254
Mailing Address - Street 1:PO BOX 81337
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1337
Mailing Address - Country:US
Mailing Address - Phone:337-233-0254
Mailing Address - Fax:337-233-5399
Practice Address - Street 1:208 HIDDEN GROVE PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4329
Practice Address - Country:US
Practice Address - Phone:337-233-0254
Practice Address - Fax:337-233-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793566Medicaid
LA5B111Medicare PIN