Provider Demographics
NPI:1518622158
Name:EMPOWER PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-931-4262
Mailing Address - Street 1:PO BOX 74732
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70874-4732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7717 HOWELL BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5583
Practice Address - Country:US
Practice Address - Phone:225-306-3013
Practice Address - Fax:225-396-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty