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General NPI Number Information
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NPI Number | 1831379486
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Entity Type | Organization
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Legal Business Name | SIMBA REHAB, LLC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1149 TRAVERS LN
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City | CORDOVA
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State | TN
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Zip | 38018-8835
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Country | US
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Telephone | 901-292-4906
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Fax | 901-386-7783
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Provider Business Mailing Address
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Address Line | 1149 TRAVERS LN
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City | CORDOVA
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State | TN
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Zip | 38018-8835
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Country | US
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Telephone | 901-292-4906
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Fax | 901-386-7783
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Authorized Official
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Title or Position | PT/CHIEF MANAGER
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Name | MR. SALIM AHMED ABDUN
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Credential | PT
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Telephone | 901-292-4906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | PT0000005160
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License Number State | TN
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