Provider Demographics
NPI:1558599118
Name:ECLIPSE WELLNESS AND PERFORMANCE CENTER, LLC
Entity Type:Organization
Organization Name:ECLIPSE WELLNESS AND PERFORMANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-588-2688
Mailing Address - Street 1:5635 MAIN ST
Mailing Address - Street 2:SUITE A PMB207
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4083
Mailing Address - Country:US
Mailing Address - Phone:225-588-2688
Mailing Address - Fax:225-261-9227
Practice Address - Street 1:1735 THOMAS H DELPIT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6633
Practice Address - Country:US
Practice Address - Phone:225-588-2688
Practice Address - Fax:225-261-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy