Organization
BRPT-LAKE REHABILITATION CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELANIE GALLEGOS SR. CPA (CHIEF FINANCIAL OFFICER)
(225) 231-3814
Entity
Organization
Contact information
Practice address
503 COLONIAL DR, BATON ROUGE, LA 70806-6508
(225) 231-3800
(225) 231-3803
Mailing address
530 SHADOWS LN, BATON ROUGE, LA 70806-6530
(225) 927-9185
(225) 231-3818
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115726
COVENTRY PROVIDER NUMBER
LA
01
—
4431096
AETNA PROVIDER NUMBER
LA
01
—
6400005
UNITED PROVIDER NUMBER
LA
01
—
7711822
CIGNA PROVIDER NUMBER
LA
01
—
G0052
BCBSLA PROVIDER NUMBER
LA
Enumeration date
11/17/2005
Last updated
09/10/2007
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