Provider Demographics
NPI:1528104882
Name:ROSEWOOD REHABILITATION, LLC
Entity type:Organization
Organization Name:ROSEWOOD REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BULLER
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:337-406-0808
Mailing Address - Street 1:626 VEROT SCHOOL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5094
Mailing Address - Country:US
Mailing Address - Phone:337-406-0808
Mailing Address - Fax:337-406-0848
Practice Address - Street 1:626 VEROT SCHOOL RD
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5094
Practice Address - Country:US
Practice Address - Phone:337-406-0808
Practice Address - Fax:337-406-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C466Medicare ID - Type Unspecified