Healthcare Provider Details

I. General information

NPI: 1821192097
Provider Name (Legal Business Name): RAINBOW REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAGLES POINTE PKWY
STOCKBRIDGE GA
30281-6384
US

IV. Provider business mailing address

261 MONTROSE DR
MCDONOUGH GA
30253-4243
US

V. Phone/Fax

Practice location:
  • Phone: 678-432-4755
  • Fax:
Mailing address:
  • Phone: 678-432-4755
  • Fax: 678-432-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOAN EBERSOLE
Title or Position: PRESIDENT
Credential: OT
Phone: 678-432-4755