MEDICARE: ADVANCED REHAB AND MEDICAL PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1083846703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED REHAB AND MEDICAL PC

Provider Business Mailing Address
First Line	:	2012 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-664-6998
Fax Number	:	731-664-7161

Provider Business Practice Location Address
First Line	:	2012 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-664-6998
Fax Number	:	731-664-7161

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SHERRI U BONE
Credential	:
Telephone Number	:	731-664-6998

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	09/30/2010

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