Provider Demographics
NPI:1174870661
Name:ACCELERATED REHAB AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:ACCELERATED REHAB AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-859-3922
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-0178
Mailing Address - Country:US
Mailing Address - Phone:985-859-3922
Mailing Address - Fax:
Practice Address - Street 1:22140 HWY. 20
Practice Address - Street 2:SUITE A
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-0000
Practice Address - Country:US
Practice Address - Phone:985-859-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03218261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy