Healthcare Provider Details

I. General information

NPI: 1952383093
Provider Name (Legal Business Name): BASS PHYSICAL THERAPY AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FAIRVIEW PARK DR
DUBLIN GA
31021-2501
US

IV. Provider business mailing address

101 FAIRVIEW PARK DR PO BOX 883
DUBLIN GA
31021-2501
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-7494
  • Fax: 478-272-2616
Mailing address:
  • Phone: 478-272-7494
  • Fax: 478-272-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E BASS JR.
Title or Position: PRESIDENT/OWNER
Credential: RPT
Phone: 478-272-7494