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General NPI Number Information
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NPI Number | 1538806500
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Entity Type | Organization
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Legal Business Name | TRI-VISTA REHAB TN, LLC
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 8617 HAVENHURST DR
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City | GERMANTOWN
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State | TN
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Zip | 38138-7734
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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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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 | PRACTICE MANAGER
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Name | KATHY SIMPSON
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Credential |
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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