Provider Demographics
NPI:1063693802
Name:REHABILITATION SOLUTIONS, PLLC
Entity type:Organization
Organization Name:REHABILITATION SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STURDAVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-0001
Mailing Address - Street 1:1104 W 1ST ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4357
Mailing Address - Country:US
Mailing Address - Phone:601-425-0001
Mailing Address - Fax:601-425-9299
Practice Address - Street 1:1104 W 1ST ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4357
Practice Address - Country:US
Practice Address - Phone:601-425-0001
Practice Address - Fax:601-425-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16798208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS16798OtherSTATE LICENSE
MS00122797Medicaid
MS16798OtherSTATE LICENSE