Healthcare Provider Details

I. General information

NPI: 1710039656
Provider Name (Legal Business Name): REHABILITATION SERVICES OF CLEVELAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N CHRISMAN AVE SUITE C
CLEVELAND MS
38732-2107
US

IV. Provider business mailing address

712 N CHRISMAN AVE SUITE C
CLEVELAND MS
38732-2107
US

V. Phone/Fax

Practice location:
  • Phone: 662-843-3004
  • Fax: 662-843-0820
Mailing address:
  • Phone: 662-843-3004
  • Fax: 662-843-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1494
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0355
License Number StateMS

VIII. Authorized Official

Name: MRS. ANN H. HERRICK
Title or Position: BILLING
Credential:
Phone: 662-843-3004