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General NPI Number Information
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NPI Number | 1063804185
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Entity Type | Organization
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Legal Business Name | COLUMBIA REHABILITATION LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 70 COLUMBIA PURVIS ROAD SUITE B
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City | COLUMBIA
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State | MS
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Zip | 39429
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Country | US
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Telephone | 601-444-9200
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Fax | 601-444-9090
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Provider Business Mailing Address
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Address Line | PO BOX 646
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City | COLUMBIA
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State | MS
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Zip | 39429-0646
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Country | US
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Telephone | 601-444-9200
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Fax | 601-444-9090
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JULIE FREEMAN
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Credential | DPT
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Telephone | 601-441-7182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT4058
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License Number State | MS
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