MEDICARE: OMEGA REHABILITATION GROUP

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	5958	TN

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	:	1700996949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA REHABILITATION GROUP

Provider Business Mailing Address
First Line	:	PO BOX 751982
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38175-1982
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 STEVENS LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37218-1205
Country	:	US
Telephone Number	:	901-346-0010
Fax Number	:	901-346-0012

Authorized Official
Title or Position	:	CEO/CLINICAL SPECIALIST
Name	:	CARLOS CATHEY
Credential	:	PT
Telephone Number	:	901-346-0010

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/25/2007

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