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General NPI Number Information
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NPI Number | 1558580696
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Entity Type | Organization
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Legal Business Name | ALL SOUTH PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 5624 ERLANGER RD
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City | KENNER
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State | LA
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Zip | 70065-1564
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Country | US
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Telephone | 504-301-1310
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Fax | 504-466-6367
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Provider Business Mailing Address
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Address Line | 5624 ERLANGER RD
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City | KENNER
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State | LA
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Zip | 70065-1564
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Country | US
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Telephone | 504-301-1310
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Fax | 504-466-6367
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. CRYSTAL ADAMS BONURA
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Credential | MPT
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Telephone | 504-909-8773
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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 | 04130
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License Number State | LA
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