1518277607 NPI number — TOTAL REHABILITATION, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518277607 NPI number — TOTAL REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL REHABILITATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518277607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-452-7773
Provider Business Mailing Address Fax Number:
479-452-7774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NO. BROADWAY SUITE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTEAU
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-452-7773
Provider Business Practice Location Address Fax Number:
479-452-7774
Provider Enumeration Date:
10/07/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
479-452-7773

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1835 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)