Healthcare Provider Details

I. General information

NPI: 1578202859
Provider Name (Legal Business Name): REHAB ONE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NORTHSIDE DR
VALDOSTA GA
31602-1802
US

IV. Provider business mailing address

420 NORTHSIDE DR
VALDOSTA GA
31602-1802
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-8001
  • Fax:
Mailing address:
  • Phone: 229-333-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERT DELOACH
Title or Position: OWNER
Credential:
Phone: 229-333-8001