Provider Demographics
NPI:1225317597
Name:VERZOSA AGUSTIN CORPORATION
Entity Type:Organization
Organization Name:VERZOSA AGUSTIN CORPORATION
Other - Org Name:CORE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:AGUSTIN
Authorized Official - Last Name:VERZOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-312-6325
Mailing Address - Street 1:4834 FOWLER DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-7704
Mailing Address - Country:US
Mailing Address - Phone:423-312-6315
Mailing Address - Fax:
Practice Address - Street 1:1293 HIGHWAY 11W
Practice Address - Street 2:SUITE B
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5810
Practice Address - Country:US
Practice Address - Phone:423-312-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT2169261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEMPLOYER IDENTIFICATION NUMBER