Healthcare Provider Details

I. General information

NPI: 1275573073
Provider Name (Legal Business Name): REHAB DYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NORTHPARK BLVD. SUITE 205
COVINGTON LA
70433-6125
US

IV. Provider business mailing address

103 NORTHPARK BLVD. SUITE 205
COVINGTON LA
70433-6125
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-7878
  • Fax: 985-871-9355
Mailing address:
  • Phone: 985-871-7878
  • Fax: 985-871-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLA00435
License Number StateLA

VIII. Authorized Official

Name: SUSAN H. BLANCHARD
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 985-871-7878