Provider Demographics
NPI:1316096555
Name:REHAB POTENTIAL, LLC
Entity type:Organization
Organization Name:REHAB POTENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:HINMAN
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:706-647-1717
Mailing Address - Street 1:317 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3502
Mailing Address - Country:US
Mailing Address - Phone:706-647-1717
Mailing Address - Fax:706-647-3737
Practice Address - Street 1:317 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3502
Practice Address - Country:US
Practice Address - Phone:706-647-1717
Practice Address - Fax:706-647-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA815225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G670003Medicare PIN
GA6265250001Medicare NSC