Provider Demographics
NPI:1710177431
Name:ENCORE REHABILITATION, INC
Entity Type:Organization
Organization Name:ENCORE REHABILITATION, INC
Other - Org Name:ENCORE REHAB OF GARDENDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-350-1764
Mailing Address - Street 1:1908 FLINT RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6031
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:919 SHARIT AVE
Practice Address - Street 2:STE 101
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-5006
Practice Address - Country:US
Practice Address - Phone:256-340-9708
Practice Address - Fax:256-340-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherORGANIZATIONAL NPI FOR GR
AL529917620Medicaid
ALK531Medicare PIN