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General NPI Number Information
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NPI Number | 1366473282
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Entity Type | Organization
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Legal Business Name | FAITH REHAB HEALTHCARE, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1750 MADISON AVE SUITE 120
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City | MEMPHIS
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State | TN
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Zip | 38104-6492
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Country | US
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Telephone | 901-725-2000
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Fax | 901-725-2002
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Provider Business Mailing Address
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Address Line | 1750 MADISON AVE SUITE 120
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City | MEMPHIS
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State | TN
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Zip | 38104-6492
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Country | US
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Telephone | 901-725-2000
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Fax | 901-725-2002
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. FATIMA L LAQUINDANUM
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Credential | PT
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Telephone | 901-725-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 103140
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 5144
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License Number State | TN
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