Provider Demographics
NPI:1558901736
Name:AT HOME PHYSICAL REHABILITATION GROUP, LLC
Entity Type:Organization
Organization Name:AT HOME PHYSICAL REHABILITATION GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROQUE
Authorized Official - Middle Name:FLESTADO
Authorized Official - Last Name:ESTIPONA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:901-461-5787
Mailing Address - Street 1:856 WILLOW TREE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-794-7988
Mailing Address - Fax:901-794-7877
Practice Address - Street 1:856 WILLOW TREE CIRCLE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-794-7988
Practice Address - Fax:901-794-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty