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General NPI Number Information
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NPI Number | 1942850102
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Entity Type | Organization
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Legal Business Name | MOBILITY REHAB LLC - EASTDALE ESTATES
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 5801 EASTDALE DR APT 122
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City | MONTGOMERY
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State | AL
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Zip | 36117-2160
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Country | US
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Telephone | 601-209-7697
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Fax | 601-487-6169
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Provider Business Mailing Address
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Address Line | PO BOX 1227
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City | RIDGELAND
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State | MS
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Zip | 39158-1227
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Country | US
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Telephone | 601-209-7697
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Fax | 601-487-6169
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MRS. SARAH BECKSTEAD
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Credential |
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Telephone | 601-209-7697
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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 |
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License Number State |
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