Provider Demographics
NPI:1700479607
Name:FAYETTEVILLE REHAB SOLUTIONS LLC
Entity Type:Organization
Organization Name:FAYETTEVILLE REHAB SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-531-0793
Mailing Address - Street 1:535 GLYNN ST S STE 20082009
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2029
Mailing Address - Country:US
Mailing Address - Phone:770-703-3143
Mailing Address - Fax:770-703-3162
Practice Address - Street 1:535 GLYNN ST S STE 20082009
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2029
Practice Address - Country:US
Practice Address - Phone:770-703-3143
Practice Address - Fax:770-703-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty