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General NPI Number Information
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NPI Number | 1265025522
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Entity Type | Organization
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Legal Business Name | TRI-VISTA REHAB, INC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 411 OAK ST.
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City | RICHTON
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State | MS
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Zip | 39476
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Country | US
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Telephone | 662-270-6486
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Fax | 662-842-7915
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Provider Business Mailing Address
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Address Line | PO BOX 3592
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City | TUPELO
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State | MS
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Zip | 38803-3592
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Country | US
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Telephone | 662-840-0535
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Fax | 662-842-7915
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN BOUTIN
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Credential | OTR
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Telephone | 662-840-0535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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