Provider Demographics
NPI:1598469074
Name:A AFFORDABLE REHAB & MASSAGE
Entity Type:Organization
Organization Name:A AFFORDABLE REHAB & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-870-1585
Mailing Address - Street 1:119 RACINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2729
Mailing Address - Country:US
Mailing Address - Phone:901-870-1585
Mailing Address - Fax:901-791-4390
Practice Address - Street 1:119 RACINE ST STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2729
Practice Address - Country:US
Practice Address - Phone:901-870-1585
Practice Address - Fax:901-791-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMT0000003749OtherSTATE LICENSE NUMBER