MEDICARE: ACCEPTANCE PHYSICAL MEDICINE & REHAB CLINIC, 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	170100000X	Ph.D. Medical Genetics	AP02346	LA

General Provider Information

NPI Number	:	1962644641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCEPTANCE PHYSICAL MEDICINE & REHAB CLINIC, LLC

Provider Business Mailing Address
First Line	:	2708 WOODDALE BLVD
Second Line	:	SUITE A2
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-7541
Country	:	US
Telephone Number	:	225-382-3920
Fax Number	:	225-382-3925

Provider Business Practice Location Address
First Line	:	2708 WOODDALE BLVD
Second Line	:	SUITE A2
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-7541
Country	:	US
Telephone Number	:	225-382-3920
Fax Number	:	225-382-3925

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SHARITA DAVIS ACKLIN
Credential	:
Telephone Number	:	225-382-3920

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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