Healthcare Provider Details

I. General information

NPI: 1093797722
Provider Name (Legal Business Name): BRPT-LAKE REHABILITATION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 COLONIAL DR
BATON ROUGE LA
70806-6508
US

IV. Provider business mailing address

530 SHADOWS LN
BATON ROUGE LA
70806-6530
US

V. Phone/Fax

Practice location:
  • Phone: 225-231-3800
  • Fax: 225-231-3803
Mailing address:
  • Phone: 225-927-9185
  • Fax: 225-231-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MELANIE GALLEGOS SR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 225-231-3814