Provider Demographics
NPI:1336453281
Name:PREMIER REHAB LLC
Entity Type:Organization
Organization Name:PREMIER REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, SLP
Authorized Official - Phone:225-644-7044
Mailing Address - Street 1:211 EAST WORTHEY RD
Mailing Address - Street 2:PREMIER REHAB
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-644-7044
Mailing Address - Fax:225-644-4414
Practice Address - Street 1:211 EAST RD
Practice Address - Street 2:PREMIER REHAB
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-644-7044
Practice Address - Fax:225-644-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty