Provider Demographics
NPI:1841236700
Name:MAX REHAB, LLC
Entity type:Organization
Organization Name:MAX REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:225-683-1111
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-1291
Mailing Address - Country:US
Mailing Address - Phone:225-683-1111
Mailing Address - Fax:225-683-1177
Practice Address - Street 1:9609 PLANK RD
Practice Address - Street 2:SUITE P
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3702
Practice Address - Country:US
Practice Address - Phone:225-683-1111
Practice Address - Fax:225-683-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty