Healthcare Provider Details

I. General information

NPI: 1265610265
Provider Name (Legal Business Name): POLK REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 MCWILLIE DR
JACKSON MS
39206-5608
US

IV. Provider business mailing address

4798 MCWILLIE DR
JACKSON MS
39206-5608
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-7649
  • Fax:
Mailing address:
  • Phone: 601-362-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JO LYNN POLK
Title or Position: PRESIDENT
Credential:
Phone: 601-238-1047