Healthcare Provider Details

I. General information

NPI: 1780908475
Provider Name (Legal Business Name): REHAB IN MOTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKE RIDGE DR
MADISON MS
39110-8291
US

IV. Provider business mailing address

110 LAKE RIDGE DR
MADISON MS
39110-8291
US

V. Phone/Fax

Practice location:
  • Phone: 601-898-8111
  • Fax:
Mailing address:
  • Phone: 601-898-8111
  • Fax:

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

VIII. Authorized Official

Name: DARON WALTERS
Title or Position: MANAGER
Credential:
Phone: 601-573-9712