Provider Demographics
NPI:1841783818
Name:ALEXANDRIA REHABILITATION , LLC
Entity Type:Organization
Organization Name:ALEXANDRIA REHABILITATION , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENABURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-449-1370
Mailing Address - Street 1:1813 NORTHPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3879
Mailing Address - Country:US
Mailing Address - Phone:318-255-7591
Mailing Address - Fax:318-255-7584
Practice Address - Street 1:104 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-449-1370
Practice Address - Fax:318-449-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty