Healthcare Provider Details

I. General information

NPI: 1922542646
Provider Name (Legal Business Name): ANCHOR REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 S TATE ST STE E
CORINTH MS
38834-7913
US

IV. Provider business mailing address

2106 S TATE ST STE E
CORINTH MS
38834-7913
US

V. Phone/Fax

Practice location:
  • Phone: 662-415-2782
  • Fax:
Mailing address:
  • Phone: 662-415-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5534
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2957
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3887
License Number StateMS

VIII. Authorized Official

Name: PATRICK WAYNE HINTON
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 662-415-2782