Provider Demographics
NPI:1306962899
Name:ORTHOPEDIC REHABILITATION, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-2363
Mailing Address - Street 1:2015 HIGHWAY 15 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1838
Mailing Address - Country:US
Mailing Address - Phone:601-425-2363
Mailing Address - Fax:601-425-3201
Practice Address - Street 1:2015 HIGHWAY 15 N
Practice Address - Street 2:SUITE A
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1838
Practice Address - Country:US
Practice Address - Phone:601-425-2363
Practice Address - Fax:601-425-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy