Provider Demographics
NPI:1881767804
Name:THERAPY FIRST OUTPATIENT REHABILITATION LLC
Entity type:Organization
Organization Name:THERAPY FIRST OUTPATIENT REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCOLUMN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-371-5257
Mailing Address - Street 1:5451 ROBINSON ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4138
Mailing Address - Country:US
Mailing Address - Phone:601-371-5257
Mailing Address - Fax:601-371-9986
Practice Address - Street 1:5451 ROBINSON ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4138
Practice Address - Country:US
Practice Address - Phone:601-371-5257
Practice Address - Fax:601-371-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-12-09
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
MS9015259Medicaid
MS9015259Medicaid