Provider Demographics
NPI:1356354070
Name:PROFESSIONAL REHAB ASSOCIATES, PC
Entity type:Organization
Organization Name:PROFESSIONAL REHAB ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:731-925-4596
Mailing Address - Street 1:10 SHILOH FALLS CT
Mailing Address - Street 2:
Mailing Address - City:COUNCE
Mailing Address - State:TN
Mailing Address - Zip Code:38326-4239
Mailing Address - Country:US
Mailing Address - Phone:731-689-0193
Mailing Address - Fax:731-925-7437
Practice Address - Street 1:880 PICKWICK ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3071
Practice Address - Country:US
Practice Address - Phone:731-925-4596
Practice Address - Fax:731-925-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006067225100000X
TNPT0000005531225100000X
TNOT3314225X00000X
TNOT3637225X00000X
TNOT1251225X00000X
TNPT0000007304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty