Healthcare Provider Details

I. General information

NPI: 1437159852
Provider Name (Legal Business Name): BOULET REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 REPRESENTATIVE ROW
LAFAYETTE LA
70508-3833
US

IV. Provider business mailing address

119 REPRESENTATIVE ROW
LAFAYETTE LA
70508-3833
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-9856
  • Fax: 337-261-5042
Mailing address:
  • Phone: 337-264-9856
  • Fax: 337-261-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0678
License Number StateLA

VIII. Authorized Official

Name: MS. PATRICIA ANN BOULET
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: P.T.
Phone: 337-264-9856