Healthcare Provider Details

I. General information

NPI: 1932667318
Provider Name (Legal Business Name): ENCORE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 RACETRACK RD NW STE B
FORT WALTON BEACH FL
32547-1644
US

IV. Provider business mailing address

251 JOHNSTON ST SE STE 200
DECATUR AL
35601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 850-344-7500
  • Fax:
Mailing address:
  • Phone: 256-350-1764
  • Fax: 256-355-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL HENDERSON
Title or Position: PRESIDENT
Credential:
Phone: 256-350-1764