Provider Demographics
NPI:1174867253
Name:ENCORE REHABILITATION INC
Entity Type:Organization
Organization Name:ENCORE REHABILITATION INC
Other - Org Name:ENCORE REHAB OF STARKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-350-1764
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:450 HIGHWAY 12 W
Practice Address - Street 2:SUITE D
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3697
Practice Address - Country:US
Practice Address - Phone:662-324-1314
Practice Address - Fax:662-324-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-30
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
MS1033218524OtherGROUP NPI
MS09015077Medicaid
MSC02726Medicare PIN