Provider Demographics
| NPI: | 1073125662 |
|---|---|
| Name: | REHAB AT YOUR SPACE, LLC |
| Entity Type: | Organization |
| Organization Name: | REHAB AT YOUR SPACE, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | JENNA |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | AUSTIN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 901-409-1017 |
| Mailing Address - Street 1: | 6320 N QUAIL HOLLOW RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MEMPHIS |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 38120-1420 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 901-409-1017 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 6320 N QUAIL HOLLOW RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MEMPHIS |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 38120-1420 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 901-409-1017 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-08-17 |
| Last Update Date: | 2020-08-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
