Provider Demographics
NPI:1740661883
Name:GULF STATES REHABILITATION & ASSOCIATES
Entity type:Organization
Organization Name:GULF STATES REHABILITATION & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:504-456-5160
Mailing Address - Street 1:4224 HOUMA BLVD STE 470
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2980
Mailing Address - Country:US
Mailing Address - Phone:504-456-5160
Mailing Address - Fax:504-456-5021
Practice Address - Street 1:4224 HOUMA BLVD STE 470
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2980
Practice Address - Country:US
Practice Address - Phone:504-456-5160
Practice Address - Fax:504-456-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAD.O.0818OR208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty