Healthcare Provider Details

I. General information

NPI: 1467602839
Provider Name (Legal Business Name): SOVEREIGN REHABILITATION OF ARLINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 AIRLINE RD SUITE 106
ARLINGTON TN
38002-9878
US

IV. Provider business mailing address

6050 AIRLINE RD SUITE 106
ARLINGTON TN
38002-9878
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-8989
  • Fax: 901-867-8757
Mailing address:
  • Phone: 901-867-8989
  • Fax: 901-867-8757

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. BOBBY ROUSE JR.
Title or Position: PRESIDENT
Credential:
Phone: 901-213-2340