Provider Demographics
NPI:1972558641
Name:REHABILITATION & SPORTS CARE CENTER LLC
Entity type:Organization
Organization Name:REHABILITATION & SPORTS CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-747-3422
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-0971
Mailing Address - Country:US
Mailing Address - Phone:985-747-3422
Mailing Address - Fax:985-747-3424
Practice Address - Street 1:14159 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-4603
Practice Address - Country:US
Practice Address - Phone:985-747-3422
Practice Address - Fax:985-747-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF3493OtherBLUE CROSS
LA=========OtherTRICARE
LAF3493OtherBLUE CROSS
LA=========OtherUNITED HEALTHCARE