Organization
CENTURY 2 THERAPY DIVISION STREET CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK LELAND GUIDRY (CEO)
(504) 293-4000
Entity
Organization
Contact information
Practice address
3901 HOUMA BLVD, STE 113, METAIRIE, LA 70006-2930
(504) 888-1330
(504) 888-6201
Mailing address
3901 HOUMA BLVD, STE 113, METAIRIE, LA 70006-2930
(504) 888-1330
(504) 888-6201
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1113671
—
LA
01
—
7307358
AETNA PROVIDER NUMBER
LA
Enumeration date
06/23/2005
Last updated
08/22/2020
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