Provider Demographics
NPI:1104032465
Name:REHAB, ETC., INC.
Entity Type:Organization
Organization Name:REHAB, ETC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-759-1282
Mailing Address - Street 1:871 RIDGEWAY LOOP RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4026
Mailing Address - Country:US
Mailing Address - Phone:901-759-1282
Mailing Address - Fax:901-759-1290
Practice Address - Street 1:871 RIDGEWAY LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4026
Practice Address - Country:US
Practice Address - Phone:901-759-1282
Practice Address - Fax:901-759-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN204667225100000X, 2251G0304X, 2251N0400X, 2251X0800X, 225400000X, 235Z00000X
TN0446575261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446575Medicaid
TN446575Medicare PIN