1437159852 NPI number — BOULET REHABILITATION SERVICES, INC.

Table of content: (NPI 1437159852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437159852 NPI number — BOULET REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOULET REHABILITATION SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437159852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 REPRESENTATIVE ROW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-264-9856
Provider Business Mailing Address Fax Number:
337-261-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 REPRESENTATIVE ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-264-9856
Provider Business Practice Location Address Fax Number:
337-261-5042
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOULET
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
337-264-9856

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT0678 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1555321 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com