Healthcare Provider Details

I. General information

NPI: 1972558641
Provider Name (Legal Business Name): REHABILITATION & SPORTS CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14159 HIGHWAY 16
AMITE LA
70422-4603
US

IV. Provider business mailing address

PO BOX 971
AMITE LA
70422-0971
US

V. Phone/Fax

Practice location:
  • Phone: 985-747-3422
  • Fax: 985-747-3424
Mailing address:
  • Phone: 985-747-3422
  • Fax: 985-747-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name: BRENNAN C KELSEY
Title or Position: OWNER
Credential: PT
Phone: 985-747-3422