Provider Demographics
NPI:1942308689
Name:CANCER REHAB & EDEMA SPECIALIST
Entity Type:Organization
Organization Name:CANCER REHAB & EDEMA SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:251-344-4212
Mailing Address - Street 1:4715 AIRPORT BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3181
Mailing Address - Country:US
Mailing Address - Phone:251-344-4212
Mailing Address - Fax:251-344-4302
Practice Address - Street 1:4715 AIRPORT BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3181
Practice Address - Country:US
Practice Address - Phone:251-344-4212
Practice Address - Fax:251-344-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933333Medicaid
AL009933333Medicaid
5461710001Medicare NSC