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NPI Code Detail

MEDICARE: RESTORATION HEALTH OF SOUTH ALABAMA, INC

MEDICARE: RESTORATION HEALTH OF SOUTH ALABAMA, INC
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
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1609391853
Entity Type Code : Organization
Provider Name (Legal Business Name) : RESTORATION HEALTH OF SOUTH ALABAMA, INC
Provider Business Mailing Address
First Line : 3280 DAUPHIN ST BLDG A
Second Line :
City : MOBILE
State : AL
Zip : 36606-4060
Country : US
Telephone Number : 251-450-3700
Fax Number : 251-545-3010
Provider Business Practice Location Address
First Line : 30762 STATE HIGHWAY 181
Second Line :
City : SPANISH FORT
State : AL
Zip : 36527-5672
Country : US
Telephone Number : 251-626-0732
Fax Number : 251-272-1983
Authorized Official
Title or Position : PRESIDENT
Name : DR. JONATHAN CLAY RAINER
Credential : MD
Telephone Number : 251-626-0732
Provider Enumeration Date : 08/09/2017
Last Update Date : 08/09/2017

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