Provider Demographics
NPI:1942625314
Name:PAIN AND PERFORMANCE REHAB, INC.
Entity Type:Organization
Organization Name:PAIN AND PERFORMANCE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:337-504-5144
Mailing Address - Street 1:1144 COOLIDGE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2622
Mailing Address - Country:US
Mailing Address - Phone:337-504-5144
Mailing Address - Fax:337-326-4545
Practice Address - Street 1:1144 COOLIDGE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2622
Practice Address - Country:US
Practice Address - Phone:337-504-5144
Practice Address - Fax:337-326-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty