Healthcare Provider Details

I. General information

NPI: 1003631169
Provider Name (Legal Business Name): NORTHEAST LOUISIANA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2601 CYPRESS ST
WEST MONROE LA
71291-4506
US

IV. Provider business mailing address

2601 CYPRESS ST
WEST MONROE LA
71291-4506
US

V. Phone/Fax

Practice location:
  • Phone: 318-582-5346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CASEY SCARBOROUGH ECKHARDT
Title or Position: OWNER
Credential:
Phone: 318-381-9337