Provider Demographics
NPI:1033499298
Name:REGGIE WHITE CARDIO-PULMONARY REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:REGGIE WHITE CARDIO-PULMONARY REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEELY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-590-4543
Mailing Address - Street 1:2715 KIRBY RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8238
Mailing Address - Country:US
Mailing Address - Phone:901-590-4543
Mailing Address - Fax:901-922-5171
Practice Address - Street 1:2715 KIRBY RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8238
Practice Address - Country:US
Practice Address - Phone:901-590-4543
Practice Address - Fax:901-922-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)