Provider Demographics
NPI:1295117273
Name:BCD REHAB & FITNESS, LLC
Entity type:Organization
Organization Name:BCD REHAB & FITNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:MEADOWS
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS
Authorized Official - Phone:912-727-2321
Mailing Address - Street 1:128 FRANCES MEEKS WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3984
Mailing Address - Country:US
Mailing Address - Phone:912-727-2321
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3984
Practice Address - Country:US
Practice Address - Phone:912-727-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15058193261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center