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General NPI Number Information
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NPI Number | 1871862003
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Entity Type | Organization
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Legal Business Name | RECONNECT THERAPY
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 1410 W QUITMAN ST
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City | IUKA
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State | MS
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Zip | 38852-1129
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Country | US
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Telephone | 662-423-3422
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Fax | 662-423-5259
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Provider Business Mailing Address
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Address Line | 1410 W QUITMAN ST
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City | IUKA
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State | MS
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Zip | 38852-1129
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Country | US
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Telephone | 662-423-3422
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Fax | 662-423-5259
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH KAVANAGH
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Credential | PT
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Telephone | 251-605-4669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 12072634
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License Number State | MS
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