Provider Demographics
NPI:1013115005
Name:REGIONAL REHABILITATION CENTER, PLLC
Entity Type:Organization
Organization Name:REGIONAL REHABILITATION CENTER, PLLC
Other - Org Name:KONALA-NUTHALAPATY, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTHALAPATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-815-1616
Mailing Address - Street 1:6290 MANCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7589
Mailing Address - Country:US
Mailing Address - Phone:931-815-1616
Mailing Address - Fax:
Practice Address - Street 1:6290 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7589
Practice Address - Country:US
Practice Address - Phone:931-815-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731374Medicaid
TN3731374Medicaid
TN3731374Medicare UPIN