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General NPI Number Information
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NPI Number | 1740622539
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Entity Type | Organization
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Legal Business Name | TOTAL REHAB, INC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 307 CHARTRESE DR
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City | BRANDON
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State | MS
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Zip | 39047-8779
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Country | US
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Telephone | 601-906-3718
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Fax |
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Provider Business Mailing Address
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Address Line | 307 CHARTRESE DR
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City | BRANDON
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State | MS
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Zip | 39047-8779
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | SCOTT WAYNE GRANTHAM
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Credential | PT
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Telephone | 601-906-3718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT3612
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License Number State | MS
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