Healthcare Provider Details

I. General information

NPI: 1639278054
Provider Name (Legal Business Name): REHAB & PAIN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 HIGHWAY 64 STE 3
LAKELAND TN
38002-8094
US

IV. Provider business mailing address

PO BOX 171422
MEMPHIS TN
38187-1422
US

V. Phone/Fax

Practice location:
  • Phone: 901-388-4474
  • Fax: 901-388-4486
Mailing address:
  • Phone: 901-870-4302
  • Fax: 901-388-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0002435
License Number StateTN

VIII. Authorized Official

Name: MRS. RESA BARAWID
Title or Position: SECRETARY
Credential: P.T.
Phone: 901-870-4302