Provider Demographics
NPI:1669509352
Name:QUALITY REHAB, INC
Entity Type:Organization
Organization Name:QUALITY REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONCURE
Authorized Official - Suffix:
Authorized Official - Credentials:PT1807
Authorized Official - Phone:601-437-0188
Mailing Address - Street 1:701 ANTHONY ST
Mailing Address - Street 2:P. O. BOX 434
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2053
Mailing Address - Country:US
Mailing Address - Phone:601-437-0188
Mailing Address - Fax:601-437-0190
Practice Address - Street 1:701 ANTHONY ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2053
Practice Address - Country:US
Practice Address - Phone:601-437-0188
Practice Address - Fax:601-437-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS256591261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS256591Medicare ID - Type Unspecified