Provider Demographics
NPI:1063804185
Name:COLUMBIA REHABILITATION LLC
Entity type:Organization
Organization Name:COLUMBIA REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-441-7182
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0646
Mailing Address - Country:US
Mailing Address - Phone:601-444-9200
Mailing Address - Fax:601-444-9090
Practice Address - Street 1:70 COLUMBIA PURVIS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-444-9200
Practice Address - Fax:601-444-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4058261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy