| Organization Name: | CUSTOM CARE THERAPY AND WELLNESS, INC. |
| NPI Number: | 1518138023 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN ROBBINS HOUSE (OWNER) |
| Mailing Address: | 1151 Highway 614 Haughton |
| State: | LA US |
| Postal Code: | 710378977 |
| Phone Number: | 3189499665 |
| Fax Number: | 3189493400 |
| NPI Enumeration Date: | 03/13/2008 |
| NPI Last Update Date: | 03/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT544 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |