Provider Demographics
NPI:1346629920
Name:HEALING HANDS REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:HEALING HANDS REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-910-7300
Mailing Address - Street 1:PO BOX 13814
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 LEXINGTON DR
Practice Address - Street 2:SUITE H
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6645
Practice Address - Country:US
Practice Address - Phone:601-910-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4561261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00571578Medicaid