Healthcare Provider Details

I. General information

NPI: 1942347687
Provider Name (Legal Business Name): BASS PHYSICAL THERAPY AND REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 VICTORY DR
SWAINSBORO GA
30401-3235
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 478-237-4017
  • Fax: 478-237-3074
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 EDWARD BASS JR.
Title or Position: PRESIDENT OWNER
Credential: RPT
Phone: 478-272-7494