Provider Demographics
NPI:1548318025
Name:TOTAL REHAB PLUS LLC
Entity type:Organization
Organization Name:TOTAL REHAB PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VON ANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-255-3533
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-864-5568
Mailing Address - Fax:228-864-4385
Practice Address - Street 1:4363 C LEISURETIME DR
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525
Practice Address - Country:US
Practice Address - Phone:228-255-3533
Practice Address - Fax:228-255-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015135Medicaid
MS09015135Medicaid