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NPI Code Detail

MEDICARE: COMMUNITY REHAB OF GREENVILLE INC

MEDICARE: COMMUNITY REHAB OF GREENVILLE 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
1225100000XPhysical Therapist
2261QP2000XPhysical Therapy Clinic/CenterNONE REQUIREDMO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1186721OTHERMOBCBS GROUP PROVIDER NUMBE
2656018OTHERMOHEALTHLINK GROUP PROVIDER

General Provider Information

NPI Number : 1801984810
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY REHAB OF GREENVILLE INC
Provider Business Mailing Address
First Line : PO BOX 7066
Second Line :
City : GULFPORT
State : MS
Zip : 39506-7066
Country : US
Telephone Number : 228-436-0999
Fax Number : 228-436-0990
Provider Business Practice Location Address
First Line : 3808 S LINDBERGH BLVD
Second Line : SUITE 105
City : SAINT LOUIS
State : MO
Zip : 63127-1367
Country : US
Telephone Number : 314-843-7800
Fax Number : 314-843-7804
Authorized Official
Title or Position : VICE PRESIDENT
Name : MS. MELANIE L FAYARD
Credential : P.T.
Telephone Number : 228-436-0999
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/02/2008

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