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General NPI Number Information
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NPI Number | 1760843866
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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 | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 120 E MAIN ST
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City | FLORENCE
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State | MS
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Zip | 39073-8410
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Country | US
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Telephone | 601-845-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 2187 HIGHWAY 51 SUITE B
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City | MADISON
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State | MS
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Zip | 39110-7491
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Country | US
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Telephone | 601-707-3296
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SCOTT GRANTHAM
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Credential | MPT
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Telephone | 601-707-3296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTA3839
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License Number State | MS
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