Healthcare Provider Details

I. General information

NPI: 1568815744
Provider Name (Legal Business Name): REHAB TECHNOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 GOODMAN RD E
SOUTHAVEN MS
38671-9504
US

IV. Provider business mailing address

1890 GOODMAN RD E
SOUTHAVEN MS
38671-9504
US

V. Phone/Fax

Practice location:
  • Phone: 662-269-0420
  • Fax: 662-589-6525
Mailing address:
  • Phone: 662-269-0420
  • Fax: 662-589-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTA3236
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0732
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST3991
License Number StateMS

VIII. Authorized Official

Name: INDRAKSHI DUBEY
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 662-269-0420