Provider Demographics
NPI:1922542646
Name:ANCHOR REHABILITATION LLC
Entity Type:Organization
Organization Name:ANCHOR REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:662-415-2782
Mailing Address - Street 1:2106 S TATE ST STE E
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7913
Mailing Address - Country:US
Mailing Address - Phone:662-415-2782
Mailing Address - Fax:
Practice Address - Street 1:2106 S TATE ST STE E
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7913
Practice Address - Country:US
Practice Address - Phone:662-415-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5534225100000X
MS2957225X00000X
MSS3887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty