Provider Demographics
NPI:1942023320
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 1:42465 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7052
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:
Practice Address - Street 1:499 GLOSTER CREEK VLG STE F1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4705
Practice Address - Country:US
Practice Address - Phone:662-269-8006
Practice Address - Fax:662-269-8007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCORE REHABILITATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty