Provider Demographics
NPI:1427084920
Name:SUPERIOR REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:SUPERIOR REHABILITATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT, DPT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:985-641-2866
Mailing Address - Street 1:85 WHISPERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1136
Mailing Address - Country:US
Mailing Address - Phone:985-641-2866
Mailing Address - Fax:985-781-5395
Practice Address - Street 1:85 WHISPERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1136
Practice Address - Country:US
Practice Address - Phone:985-641-2866
Practice Address - Fax:985-781-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04523261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1134228Medicaid
LA1134228Medicaid