Provider Demographics
NPI:1942494141
Name:GULF STATES REHABILITATION ASSOCIATES,LTD.
Entity Type:Organization
Organization Name:GULF STATES REHABILITATION ASSOCIATES,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:504-456-5160
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-456-5160
Mailing Address - Fax:504-456-5021
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-456-5160
Practice Address - Fax:504-456-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08180R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57562Medicare PIN