Provider Demographics
NPI:1750442844
Name:ADVANCED REHABILITATION OF METAIRIE
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION OF METAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-753-9491
Mailing Address - Street 1:4621 W NAPOLEON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2487
Mailing Address - Country:US
Mailing Address - Phone:504-889-1193
Mailing Address - Fax:504-889-1194
Practice Address - Street 1:4621 W NAPOLEON
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-889-1193
Practice Address - Fax:504-889-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X
LA25283056261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA349908400OtherDEPT OF LABOR
LA3831740440OtherBLUE CROSS
LA349908400OtherDEPT OF LABOR