Provider Demographics
NPI:1962644641
Name:ACCEPTANCE PHYSICAL MEDICINE & REHAB CLINIC, LLC
Entity Type:Organization
Organization Name:ACCEPTANCE PHYSICAL MEDICINE & REHAB CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARITA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:ACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-382-3920
Mailing Address - Street 1:2708 WOODDALE BLVD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-7541
Mailing Address - Country:US
Mailing Address - Phone:225-382-3920
Mailing Address - Fax:225-382-3925
Practice Address - Street 1:2708 WOODDALE BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7541
Practice Address - Country:US
Practice Address - Phone:225-382-3920
Practice Address - Fax:225-382-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02346170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CN18Medicare PIN