Healthcare Provider Details

I. General information

NPI: 1336453281
Provider Name (Legal Business Name): PREMIER REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 EAST RD PREMIER REHAB
GONZALES LA
70737
US

IV. Provider business mailing address

211 EAST WORTHEY RD PREMIER REHAB
GONZALES LA
70737
US

V. Phone/Fax

Practice location:
  • Phone: 225-644-7044
  • Fax: 225-644-4414
Mailing address:
  • Phone: 225-644-7044
  • Fax: 225-644-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIDGET A REDMOND
Title or Position: DIRECTOR OF OPERATIONS/OWNER
Credential: MA, SLP
Phone: 225-644-7044