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General NPI Number Information
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NPI Number | 1356319552
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Entity Type | Organization
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Legal Business Name | PREMIER REHAB & AQUATICS
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 7015 HWY 190 E SERV RD SUITE 103
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City | COVINGTON
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State | LA
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Zip | 70433-4960
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Country | US
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Telephone | 985-893-8285
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Fax | 985-893-8288
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Provider Business Mailing Address
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Address Line | 7015 HWY 190 E SERV RD SUITE 103
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City | COVINGTON
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State | LA
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Zip | 70433-4960
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Country | US
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Telephone | 985-893-8285
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Fax | 985-893-8288
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MARTIN VINCE TASSIN
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Credential | LPT
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Telephone | 985-893-8285
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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 | 00211
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License Number State | LA
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