=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952106999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GKM BUSINESS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 LAPALCO BLVD STE A
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-577-2844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 LAPALCO BLVD STE A
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-577-2844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREGORY MONROE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-577-2844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------