MEDICARE: DJ ALEX REHABILITATIVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	019475	LA

General Provider Information

NPI Number	:	1316124860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DJ ALEX REHABILITATIVE CARE LLC

Provider Business Mailing Address
First Line	:	2010 OXFORD PL
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5503
Country	:	US
Telephone Number	:	318-221-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 OXFORD PL
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5503
Country	:	US
Telephone Number	:	318-221-2535
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DALNA RODGERS
Credential	:
Telephone Number	:	318-221-2535

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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