Provider Demographics
NPI:1437159852
Name:BOULET REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:BOULET REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOULET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-264-9856
Mailing Address - Street 1:119 REPRESENTATIVE ROW
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3833
Mailing Address - Country:US
Mailing Address - Phone:337-264-9856
Mailing Address - Fax:337-261-5042
Practice Address - Street 1:119 REPRESENTATIVE ROW
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3833
Practice Address - Country:US
Practice Address - Phone:337-264-9856
Practice Address - Fax:337-261-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT0678261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1555321Medicaid
LA5CT74Medicare PIN