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General NPI Number Information
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NPI Number | 1669524161
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Entity Type | Organization
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Legal Business Name | REHABILITATION CONCEPTS PLUS, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 350 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4847
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Country | US
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Telephone | 318-220-7334
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Fax | 318-220-7017
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Provider Business Mailing Address
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Address Line | 350 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4847
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Country | US
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Telephone | 318-220-7334
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Fax | 318-220-7017
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES EDWARD JACKSON
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Credential | PHYSICAL THERAPIST
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Telephone | 318-220-7334
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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 | PT01438
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License Number State | LA
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