Healthcare Provider Details

I. General information

NPI: 1881877066
Provider Name (Legal Business Name): NAUTILUS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 WICHERS DR
MARRERO LA
70072-3002
US

IV. Provider business mailing address

PO BOX 54721
NEW ORLEANS LA
70154-4721
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-0733
  • Fax:
Mailing address:
  • Phone: 504-347-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINDY LEBOUEF
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-347-8471