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General NPI Number Information
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NPI Number | 1306304514
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Entity Type | Organization
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Legal Business Name | RIVERTOWN FAMILY REHABILITATION
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 3740 WOODRUFF RD
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City | COLUMBUS
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State | GA
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Zip | 31904-5601
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Country | US
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Telephone | 706-570-9620
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Fax | 478-956-0958
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Provider Business Mailing Address
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Address Line | PO BOX 27393
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City | MACON
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State | GA
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Zip | 31221-7393
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA HICKS
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Credential |
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Telephone | 706-570-9620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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