Provider Demographics
NPI:1215078332
Name:LA JONCTION REHABILITATION AND THERAPY INC
Entity type:Organization
Organization Name:LA JONCTION REHABILITATION AND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-754-7777
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0250
Mailing Address - Country:US
Mailing Address - Phone:337-754-7777
Mailing Address - Fax:337-754-7773
Practice Address - Street 1:235 CANAL STREET
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-0250
Practice Address - Country:US
Practice Address - Phone:337-754-7777
Practice Address - Fax:337-754-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========0OtherBLUE CROSS BLUE SHIELD
LA=========0OtherBLUE CROSS BLUE SHIELD