Provider Demographics
NPI:1578694063
Name:GENTILLY PHYSICAL THERAPY AND REHAB
Entity Type:Organization
Organization Name:GENTILLY PHYSICAL THERAPY AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-282-4406
Mailing Address - Street 1:4298 ELYSIAN FIELDS AVE
Mailing Address - Street 2:SUITE C.
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3848
Mailing Address - Country:US
Mailing Address - Phone:504-282-4406
Mailing Address - Fax:504-282-4407
Practice Address - Street 1:4298 ELYSIAN FIELDS AVE
Practice Address - Street 2:SUITE C.
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3848
Practice Address - Country:US
Practice Address - Phone:504-282-4406
Practice Address - Fax:504-282-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00559225100000X
LA06827R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty