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General NPI Number Information
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NPI Number | 1790074631
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Entity Type | Organization
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Legal Business Name | PARAGON REHAB, LLC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 323 INDUSTRIAL PARK
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City | LIBERTY
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State | MS
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Zip | 39645-8069
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Country | US
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Telephone | 601-657-1000
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Fax | 601-657-9121
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Provider Business Mailing Address
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Address Line | 323 INDUSTRIAL PARK DR
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City | LIBERTY
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State | MS
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Zip | 39645
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Country | US
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Telephone | 601-657-1000
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Fax | 601-657-9121
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SALLY MCCOY
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Credential |
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Telephone | 601-657-1000
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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 | PTA 4044
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License Number State | MS
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