Healthcare Provider Details

I. General information

NPI: 1881024156
Provider Name (Legal Business Name): ENCORE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 GEX RD SUITE B
DIAMONDHEAD MS
39525-3208
US

IV. Provider business mailing address

PO BOX 8419
BILOXI MS
39535-8087
US

V. Phone/Fax

Practice location:
  • Phone: 228-222-4765
  • Fax: 228-222-4775
Mailing address:
  • Phone: 228-388-5714
  • Fax: 228-388-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3339
License Number StateMS

VIII. Authorized Official

Name: PAUL HENDERSON
Title or Position: PRESIDENT
Credential: PT
Phone: 256-350-1764