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General NPI Number Information
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NPI Number | 1548318025
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Entity Type | Organization
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Legal Business Name | TOTAL REHAB PLUS LLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4363 C LEISURETIME DR
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City | DIAMONDHEAD
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State | MS
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Zip | 39525
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Country | US
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Telephone | 228-255-3533
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Fax | 228-255-3536
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | LONG BEACH
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State | MS
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Zip | 39560
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Country | US
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Telephone | 228-864-5568
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Fax | 228-864-4385
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ADMINISTRATOR
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Name | MS. JENNIFER MARIE VON ANTZ
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Credential | PT
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Telephone | 228-255-3533
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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 |
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License Number State |
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