Provider Demographics
NPI:1912055690
Name:TALLASSEE REHAB
Entity Type:Organization
Organization Name:TALLASSEE REHAB
Other - Org Name:CRAIN REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-283-8032
Mailing Address - Street 1:1000 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1265
Mailing Address - Country:US
Mailing Address - Phone:334-283-8032
Mailing Address - Fax:334-283-1136
Practice Address - Street 1:301 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1558
Practice Address - Country:US
Practice Address - Phone:334-725-1261
Practice Address - Fax:334-725-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-04-08
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
AL890007880Medicaid