Provider Demographics
NPI:1841438736
Name:SPECIALTY REHABILITATION GROUP INC
Entity type:Organization
Organization Name:SPECIALTY REHABILITATION GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-219-8505
Mailing Address - Street 1:10076 SUTTON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0685
Mailing Address - Country:US
Mailing Address - Phone:901-219-8505
Mailing Address - Fax:901-202-0336
Practice Address - Street 1:10076 SUTTON RIDGE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0685
Practice Address - Country:US
Practice Address - Phone:901-219-8505
Practice Address - Fax:901-202-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001006225X00000X
TN0000002224225200000X
TN1506231H00000X
TN1807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty