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General NPI Number Information
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NPI Number | 1639268071
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Entity Type | Organization
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Legal Business Name | VIP REHAB, INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1058 HOLLAND AVE
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City | PHILADELPHIA
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State | MS
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Zip | 39350-9121
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Country | US
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Telephone | 601-650-9111
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Fax | 601-650-1972
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Provider Business Mailing Address
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Address Line | 1058 HOLLAND AVE
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City | PHILADELPHIA
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State | MS
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Zip | 39350-1058
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Country | US
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Telephone | 601-650-9111
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Fax | 601-650-1972
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. TERRY MARK WINSTEAD
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Credential | OTR/L
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Telephone | 601-650-9111
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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 | PT0751
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT0928
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License Number State | MS
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