Healthcare Provider Details

I. General information

NPI: 1831168335
Provider Name (Legal Business Name): NORTHLAKE PHYSICAL THERAPY AND REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BON TEMPS ROULE
MANDEVILLE LA
70471-2555
US

IV. Provider business mailing address

100 BON TEMPS ROULE
MANDEVILLE LA
70471-2555
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-3398
  • Fax: 985-845-3001
Mailing address:
  • Phone: 985-845-3398
  • Fax: 985-845-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETH ALLBRITTON
Title or Position: OWNER
Credential: P.T.
Phone: 985-893-0778