Provider Demographics
NPI:1639278054
Name:REHAB & PAIN THERAPY
Entity Type:Organization
Organization Name:REHAB & PAIN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:RESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAWID
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-870-4302
Mailing Address - Street 1:PO BOX 171422
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1422
Mailing Address - Country:US
Mailing Address - Phone:901-870-4302
Mailing Address - Fax:901-388-4486
Practice Address - Street 1:9160 HIGHWAY 64 STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8094
Practice Address - Country:US
Practice Address - Phone:901-388-4474
Practice Address - Fax:901-388-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0002435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732731Medicare PIN