Provider Demographics
NPI:1942850102
Name:MOBILITY REHAB LLC - EASTDALE ESTATES
Entity Type:Organization
Organization Name:MOBILITY REHAB LLC - EASTDALE ESTATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-209-7697
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-1227
Mailing Address - Country:US
Mailing Address - Phone:601-209-7697
Mailing Address - Fax:601-487-6169
Practice Address - Street 1:5801 EASTDALE DR APT 122
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2160
Practice Address - Country:US
Practice Address - Phone:601-209-7697
Practice Address - Fax:601-487-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy