# CENTURY 2 THERAPY DIVISION STREET CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023014131
- **Authorized official:** MR. MARK LELAND GUIDRY (CEO)
- **Authorized official phone:** (504) 293-4000

## Contact information

- **Practice address:** 3901 HOUMA BLVD, STE 113, METAIRIE, LA 70006-2930
- **Practice address phone:** (504) 888-1330
- **Practice address fax:** (504) 888-6201
- **Mailing address:** 3901 HOUMA BLVD, STE 113, METAIRIE, LA 70006-2930
- **Mailing address phone:** (504) 888-1330
- **Mailing address fax:** (504) 888-6201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225400000X | Rehabilitation Practitioner | — | NULL | Yes |
| 225400000X | Rehabilitation Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/23/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1113671 | — | LA |
| 01 | — | 7307358 | AETNA PROVIDER NUMBER | LA |