Healthcare Provider Details

I. General information

NPI: 1942335922
Provider Name (Legal Business Name): ENCORE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CIRCLE J DR UNIT 5
LAUREL MS
39440-1980
US

IV. Provider business mailing address

PO BOX 8419
BILOXI MS
39535-8087
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-2363
  • Fax: 601-425-3201
Mailing address:
  • Phone: 228-388-5714
  • Fax: 228-388-0017

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