Provider Demographics
NPI:1275902140
Name:ROSEWOOD REHABILITATION
Entity Type:Organization
Organization Name:ROSEWOOD REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-406-0808
Mailing Address - Street 1:626 VEROT SCHOOL RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5094
Mailing Address - Country:US
Mailing Address - Phone:337-406-0808
Mailing Address - Fax:
Practice Address - Street 1:626 VEROT SCHOOL RD STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5094
Practice Address - Country:US
Practice Address - Phone:337-406-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1528104882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD63Medicare PIN