Provider Demographics
NPI:1437962313
Name:ENCORE REHABILITATION, INC.
Entity type:Organization
Organization Name:ENCORE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-350-1764
Mailing Address - Street 1:251 JOHNSTON ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2535
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:
Practice Address - Street 1:1105 39TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2654
Practice Address - Country:US
Practice Address - Phone:228-575-4654
Practice Address - Fax:228-575-4651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCORE REHABILITATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty