=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427200971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENCORE REHABILITATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2008
-----------------------------------------------------
Last Update Date | 05/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13040 N WINTZELL AVE OFFICE # 2
-----------------------------------------------------
City | BAYOU LA BATRE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36509-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-824-2882
-----------------------------------------------------
Fax | 251-824-2884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 FLINT RD SE
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601-6031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-350-1764
-----------------------------------------------------
Fax | 256-350-7757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL G HENDERSON
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 256-350-1764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------