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General NPI Number Information
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NPI Number | 1578517728
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Entity Type | Organization
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Legal Business Name | SOUTHERN LOUISIANA REHAB LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 310A YOUNGSVILLE HWY
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City | LAFAYETTE
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State | LA
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Zip | 70508-4524
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Country | US
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Telephone | 337-837-3615
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Fax | 337-839-8092
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Provider Business Mailing Address
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Address Line | PO BOX 73701
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City | METAIRIE
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State | LA
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Zip | 70033-3701
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Country | US
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Telephone | 504-888-1336
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Fax | 504-888-3362
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSEPH BOZZELLE
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Credential | MD
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Telephone | 337-837-3615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | LA
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