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General NPI Number Information
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NPI Number | 1275573073
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Entity Type | Organization
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Legal Business Name | REHAB DYNAMICS, LLC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 103 NORTHPARK BLVD. SUITE 205
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City | COVINGTON
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State | LA
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Zip | 70433-6125
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Country | US
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Telephone | 985-871-7878
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Fax | 985-871-9355
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Provider Business Mailing Address
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Address Line | 103 NORTHPARK BLVD. SUITE 205
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City | COVINGTON
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State | LA
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Zip | 70433-6125
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Country | US
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Telephone | 985-871-7878
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Fax | 985-871-9355
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SUSAN H. BLANCHARD
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Credential | PT
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Telephone | 985-871-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LA00435
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License Number State | LA
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