Healthcare Provider Details

I. General information

NPI: 1437401593
Provider Name (Legal Business Name): ENCORE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BEACH DR
GULFPORT MS
39507-1553
US

IV. Provider business mailing address

PO BOX 8419
BILOXI MS
39535-8087
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-5714
  • Fax:
Mailing address:
  • Phone: 228-388-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEIGH K USELTON
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 228-388-5714