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Organization
ACTIVE MOVEMENT REHABILITATION AND WELLNESS, LLC
Active
Organization
ACTIVE MOVEMENT REHABILITATION AND WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KANDYL K DOMANGUE OTR/L (OWNER)
(985) 209-9239
Entity
Organization
Contact information
Practice address
127 HIGHWAY 22 E, UNIT N5, MADISONVILLE, LA 70447-9306
(985) 209-9239
Mailing address
PO BOX 918, MANDEVILLE, LA 70470-0918
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.200287
LA
Other
Enumeration date
08/05/2009
Last updated
08/05/2009
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