Healthcare Provider Details

I. General information

NPI: 1033533732
Provider Name (Legal Business Name): RAINBOW REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2014
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 FUTRAL RD
GRIFFIN GA
30224-7455
US

IV. Provider business mailing address

4016 EMERSON CT
MCDONOUGH GA
30252-7077
US

V. Phone/Fax

Practice location:
  • Phone: 678-429-0272
  • Fax: 678-289-8535
Mailing address:
  • Phone: 678-429-0272
  • Fax: 678-408-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTEN WILSON
Title or Position: OWNER
Credential: PT
Phone: 678-429-0272