Healthcare Provider Details

I. General information

NPI: 1649748351
Provider Name (Legal Business Name): CHILDREN'S REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N FLOWOOD DR STE A2
FLOWOOD MS
39232-9738
US

IV. Provider business mailing address

1050 N FLOWOOD DR STE A2
FLOWOOD MS
39232-9738
US

V. Phone/Fax

Practice location:
  • Phone: 601-345-4180
  • Fax: 601-345-4790
Mailing address:
  • Phone: 601-345-4180
  • Fax: 601-345-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN ELIZABETH ROBERSON
Title or Position: PT/OWNER
Credential: PT
Phone: 601-345-4180