Provider Demographics
NPI:1306650635
Name:ENCORE REHABILITATION INC
Entity type:Organization
Organization Name:ENCORE REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-350-1764
Mailing Address - Street 1:42465 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7052
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:
Practice Address - Street 1:1105 39TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2654
Practice Address - Country:US
Practice Address - Phone:228-575-4654
Practice Address - Fax:225-575-4651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCORE REHABILIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty