Healthcare Provider Details

I. General information

NPI: 1861228512
Provider Name (Legal Business Name): JENNERATIONAL REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 BIT AND SPUR RD
MOBILE AL
36608-2646
US

IV. Provider business mailing address

4638 BIT AND SPUR RD
MOBILE AL
36608-2646
US

V. Phone/Fax

Practice location:
  • Phone: 251-699-0295
  • Fax: 251-699-0295
Mailing address:
  • Phone: 251-699-0295
  • Fax: 251-699-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARISSA BROOKE JADICK
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 251-445-3391