MEDICARE: TRINITY REHABILITATION INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225200000X	Physical Therapy Assistant
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	225100000X	Physical Therapist

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	:	1588759369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY REHABILITATION INC

Provider Business Mailing Address
First Line	:	PO BOX 315
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39158-0315
Country	:	US
Telephone Number	:	601-206-9195
Fax Number	:	601-957-8391

Provider Business Practice Location Address
First Line	:	13 NORTHTOWN DR
Second Line	:	SUITE 110
City	:	JACKSON
State	:	MS
Zip	:	39211-3047
Country	:	US
Telephone Number	:	601-206-9195
Fax Number	:	601-957-8391

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. JOSEPH KAREL SPEETJENS
Credential	:
Telephone Number	:	601-206-9195

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/17/2011

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Directions to “TRINITY REHABILITATION INC ” Practice Location

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