Healthcare Provider Details

I. General information

NPI: 1417349929
Provider Name (Legal Business Name): NORTHEAST LOUISIANA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2015
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 BOOTS DR
FARMERVILLE LA
71241-3102
US

IV. Provider business mailing address

246 ALONZO RD
WEST MONROE LA
71291-1731
US

V. Phone/Fax

Practice location:
  • Phone: 318-620-0075
  • Fax: 318-620-0070
Mailing address:
  • Phone: 318-620-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 08698
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOTT.200620
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CASEY SCARBOROUGH ECKHARDT
Title or Position: PHYSICAL AND OCCUPATIONAL THERAPIST
Credential: MOT, LOTR, PT, DPT
Phone: 318-620-0075