Provider Demographics
NPI:1780725689
Name:MAGNOLIA REHAB COMPANY
Entity type:Organization
Organization Name:MAGNOLIA REHAB COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:601-783-9840
Mailing Address - Street 1:335 E BAY ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-2815
Mailing Address - Country:US
Mailing Address - Phone:601-783-9840
Mailing Address - Fax:601-783-9040
Practice Address - Street 1:335 E BAY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2815
Practice Address - Country:US
Practice Address - Phone:601-783-9840
Practice Address - Fax:601-783-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS256593Medicare ID - Type Unspecified