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General NPI Number Information
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NPI Number | 1669692620
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC EXPREXXIONS REHAB, INC.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 122 DESOTO AVE SUITE 109
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City | CLARKSDALE
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State | MS
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Zip | 38614-4420
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Country | US
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Telephone | 662-621-1701
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Fax | 662-621-1702
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Provider Business Mailing Address
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Address Line | 122 DESOTO AVE SUITE 109
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City | CLARKSDALE
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State | MS
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Zip | 38614-4420
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Country | US
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Telephone | 662-621-1701
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Fax | 662-621-1702
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Authorized Official
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Title or Position | CEO
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Name | MS. NOLA JEAN RAYSON-LOCKE
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Credential | O.T.
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Telephone | 662-621-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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