Organization
LOUISIANA STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. GARY R GLYNN MD (HEAD OF SECTION OF P.M.&R.)
(504) 568-4624
Entity
Organization
Contact information
Practice address
5213 CITRUS BLVD APT S335, RIVER RIDGE, LA 70123-7229
(504) 343-2858
(504) 568-2127
Mailing address
2020 GRAVIER ST FL 7, NEW ORLEANS, LA 70112-2272
(504) 568-5722
(504) 568-2127
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
42398-66787
ZZ
273Y00000X
Rehabilitation Hospital Unit
42398-66787
ZZ
282E00000X
Long Term Care Hospital
42398-66787
ZZ
283X00000X
Rehabilitation Hospital
42398-66787
ZZ
Other
Enumeration date
11/10/2009
Last updated
11/10/2009
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