MEDICARE: H2 REHABILITATION EXTENSION SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0400X	Rehabilitation Clinic/Center
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841180155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H2 REHABILITATION EXTENSION SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 932184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-2184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 E WINCHESTER BLVD
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-4214
Country	:	US
Telephone Number	:	904-618-3778
Fax Number	:	904-757-9679

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	AMANDA STREETER
Credential	:
Telephone Number	:	800-699-9395

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	09/10/2025

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