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General NPI Number Information
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NPI Number | 1083850770
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Entity Type | Organization
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Legal Business Name | EXCELERATED REHAB & FITNESS LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 7 WILLOW BEND DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-8552
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Country | US
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Telephone | 601-599-0260
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Fax | 601-599-0261
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Provider Business Mailing Address
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Address Line | 7 WILLOW BEND DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-8552
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Country | US
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Telephone | 601-599-0260
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Fax | 601-599-0261
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER T STEWART
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Credential | PT
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Telephone | 601-466-9938
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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 | 3116
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License Number State | MS
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