Provider Demographics
NPI:1295868487
Name:AL IV ENTERPRISES INC
Entity type:Organization
Organization Name:AL IV ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASTASI
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:985-892-1103
Mailing Address - Street 1:9 STARBRUSH CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7246
Mailing Address - Country:US
Mailing Address - Phone:985-892-1103
Mailing Address - Fax:985-892-1889
Practice Address - Street 1:9 STARBRUSH CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7246
Practice Address - Country:US
Practice Address - Phone:985-892-1103
Practice Address - Fax:985-892-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00103214OtherRAILROAD MEDICARE
LA5CJ22Medicare ID - Type Unspecified
LAP00103214OtherRAILROAD MEDICARE