Provider Demographics
NPI:1649511197
Name:IMPAC REHABILITATION INC.
Entity type:Organization
Organization Name:IMPAC REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-779-0400
Mailing Address - Street 1:4937 HEARST ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4937 HEARST ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1120
Practice Address - Country:US
Practice Address - Phone:504-779-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty