Provider Demographics
NPI:1124163506
Name:SOUTHERN REHABILITATION CENTER
Entity type:Organization
Organization Name:SOUTHERN REHABILITATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-641-5825
Mailing Address - Street 1:1346 LINDBERG DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8081
Mailing Address - Country:US
Mailing Address - Phone:985-641-5825
Mailing Address - Fax:985-641-5895
Practice Address - Street 1:1346 LINDBERG DR STE 3
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8081
Practice Address - Country:US
Practice Address - Phone:985-641-5825
Practice Address - Fax:985-641-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty