MEDICARE: ENCORE REHABILITATION, 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
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1033218524	OTHER	MS	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700195286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 8419
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39535-8087
Country	:	US
Telephone Number	:	228-388-5714
Fax Number	:	228-388-0017

Provider Business Practice Location Address
First Line	:	5132 BEATLINE RD
Second Line	:	SUITE D
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3869
Country	:	US
Telephone Number	:	228-575-8429
Fax Number	:	228-575-8891

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	12/02/2020

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Directions to “ENCORE REHABILITATION, INC. ” Practice Location

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