Provider Demographics
NPI:1104909118
Name:TOTAL REHABILITATION, INC
Entity type:Organization
Organization Name:TOTAL REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-7773
Mailing Address - Street 1:PO BOX 11122
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1122
Mailing Address - Country:US
Mailing Address - Phone:479-452-7773
Mailing Address - Fax:479-452-7774
Practice Address - Street 1:5905 REMINGTON CIR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6523
Practice Address - Country:US
Practice Address - Phone:479-452-7773
Practice Address - Fax:479-452-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136730742Medicaid
AR5C079Medicare PIN
AR1267820001Medicare NSC