Provider Demographics
NPI:1730241829
Name:ACCEPTANCE PHYSICAL MEDICINE & REHABILITATION CLINIC, LLC
Entity type:Organization
Organization Name:ACCEPTANCE PHYSICAL MEDICINE & REHABILITATION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARITA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:ACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-5358
Mailing Address - Street 1:2156 WOODDALE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1403
Mailing Address - Country:US
Mailing Address - Phone:225-928-5358
Mailing Address - Fax:225-928-5363
Practice Address - Street 1:2156 WOODDALE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1403
Practice Address - Country:US
Practice Address - Phone:225-928-5358
Practice Address - Fax:225-928-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty