MEDICARE: ENCORE REHABILITATION OF FAIRHOPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1023461969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE REHABILITATION OF FAIRHOPE

Provider Business Mailing Address
First Line	:	251 JOHNSTON ST SE
Second Line	:	SUITE 300
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 GREENO RD S
Second Line	:	SUITE A
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-2048
Country	:	US
Telephone Number	:	251-210-2070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL HENDERSON
Credential	:
Telephone Number	:	256-350-1764

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	12/02/2020

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