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General NPI Number Information
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NPI Number | 1174870661
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Entity Type | Organization
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Legal Business Name | ACCELERATED REHAB AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 22140 HWY. 20 SUITE A
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City | VACHERIE
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State | LA
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Zip | 70090-0000
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Country | US
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Telephone | 985-859-3922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 178
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City | VACHERIE
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State | LA
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Zip | 70090-0178
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Country | US
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Telephone | 985-859-3922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK SIEGEL
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Credential | PT
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Telephone | 985-859-3922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 03218
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License Number State | LA
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