MEDICARE: ENCORE REHABILITATION OF MONTGOMERY EAST

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1275064040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE REHABILITATION OF MONTGOMERY EAST

Provider Business Mailing Address
First Line	:	251 JOHNSTON ST SE
Second Line	:	SUITE 300
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2562 EASTERN BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1500
Country	:	US
Telephone Number	:	334-523-8805
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL HENDERSON
Credential	:
Telephone Number	:	256-350-1764

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	12/02/2020

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