Healthcare Provider Details

I. General information

NPI: 1467561670
Provider Name (Legal Business Name): ALCORN REHAB SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E SHILOH RD
CORINTH MS
38834-3635
US

IV. Provider business mailing address

1708 E SHILOH RD
CORINTH MS
38834-3635
US

V. Phone/Fax

Practice location:
  • Phone: 662-284-4656
  • Fax: 662-665-0836
Mailing address:
  • Phone: 662-284-4656
  • Fax: 662-665-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5927860001
License Number StateMS

VIII. Authorized Official

Name: MICHAEL LEE STEWART
Title or Position: OWNER/PT
Credential: PHYSICAL THERAPIST
Phone: 662-284-4656