Healthcare Provider Details

I. General information

NPI: 1902643539
Provider Name (Legal Business Name): FORRESTER REHABILITAION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 DRIFTWOOD LOOP W
SEMMES AL
36575-3500
US

IV. Provider business mailing address

2430 DRIFTWOOD LOOP W
SEMMES AL
36575-3500
US

V. Phone/Fax

Practice location:
  • Phone: 251-455-1755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FORRESTER THOMAS
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 251-455-1755