=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669509352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY REHAB, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 ANTHONY ST
-----------------------------------------------------
City | PORT GIBSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39150-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-437-0188
-----------------------------------------------------
Fax | 601-437-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 ANTHONY ST P. O. BOX 434
-----------------------------------------------------
City | PORT GIBSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39150-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-437-0188
-----------------------------------------------------
Fax | 601-437-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTER PT
-----------------------------------------------------
Name | MRS. SHIRLEY D MONCURE
-----------------------------------------------------
Credential | PT1807
-----------------------------------------------------
Telephone | 601-437-0188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 256591
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------