MEDICARE: RIVER CITY REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT0169	MS
2	225100000X	Physical Therapist	PT1045	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083607220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY REHABILITATION LLC

Provider Business Mailing Address
First Line	:	1707 SOUTH COLORADO
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	MS
Zip	:	38703
Country	:	US
Telephone Number	:	662-335-8332
Fax Number	:	662-335-8852

Provider Business Practice Location Address
First Line	:	1707 SOUTH COLORADO
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	MS
Zip	:	38703
Country	:	US
Telephone Number	:	662-335-8332
Fax Number	:	662-335-8852

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. GINA L ASHFORD
Credential	:
Telephone Number	:	662-335-8332

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/07/2025

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Directions to “RIVER CITY REHABILITATION LLC ” Practice Location

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