Healthcare Provider Details

I. General information

NPI: 1114935707
Provider Name (Legal Business Name): PEARL RIVER REHAB, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FIFTH AVE
PICAYUNE MS
39466-3214
US

IV. Provider business mailing address

1000 FIFTH AVE
PICAYUNE MS
39466-3214
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-8003
  • Fax: 601-798-6050
Mailing address:
  • Phone: 601-798-8003
  • Fax: 601-798-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD H. RAMBERG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 601-798-8003