Healthcare Provider Details

I. General information

NPI: 1740622539
Provider Name (Legal Business Name): TOTAL REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CHARTRESE DR
BRANDON MS
39047-8779
US

IV. Provider business mailing address

307 CHARTRESE DR
BRANDON MS
39047-8779
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-3718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT3612
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT WAYNE GRANTHAM
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 601-906-3718