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General NPI Number Information
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NPI Number | 1033499298
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Entity Type | Organization
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Legal Business Name | REGGIE WHITE CARDIO-PULMONARY REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 2715 KIRBY RD SUITE 15
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City | MEMPHIS
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State | TN
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Zip | 38119-8238
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Country | US
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Telephone | 901-590-4543
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Fax | 901-922-5171
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Provider Business Mailing Address
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Address Line | 2715 KIRBY RD SUITE 15
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City | MEMPHIS
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State | TN
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Zip | 38119-8238
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Country | US
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Telephone | 901-590-4543
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Fax | 901-922-5171
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NEELY A EASTER
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Credential |
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Telephone | 901-590-4543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | TN
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