MEDICARE: CALCASIEU REHAB & SPORTS THERAPY

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1326175217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALCASIEU REHAB & SPORTS THERAPY

Provider Business Mailing Address
First Line	:	2100 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7864
Country	:	US
Telephone Number	:	337-310-5116
Fax Number	:	337-310-5118

Provider Business Practice Location Address
First Line	:	2100 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7864
Country	:	US
Telephone Number	:	337-310-5116
Fax Number	:	337-310-5118

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL V MOSS
Credential	:	PT
Telephone Number	:	337-310-5116

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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