Healthcare Provider Details

I. General information

NPI: 1306650635
Provider Name (Legal Business Name): ENCORE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 39TH AVE
GULFPORT MS
39501-2654
US

IV. Provider business mailing address

251 JOHNSTON ST SE STE 300
DECATUR AL
35601-2535
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-4654
  • Fax: 225-575-4651
Mailing address:
  • Phone: 256-350-1764
  • Fax: 256-274-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELSEY MCNUTT
Title or Position: PROVIDER CREDENTIALING
Credential:
Phone: 256-350-1764