Provider Demographics
NPI:1306197918
Name:MACON REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:MACON REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-385-6244
Mailing Address - Street 1:106 BUTLER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1629
Mailing Address - Country:US
Mailing Address - Phone:660-385-6244
Mailing Address - Fax:660-385-4821
Practice Address - Street 1:106 BUTLER ST
Practice Address - Street 2:SUITE C
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1629
Practice Address - Country:US
Practice Address - Phone:660-385-6244
Practice Address - Fax:660-385-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010108647261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy