# PEARL RIVER REHAB, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114935707
- **Authorized official:** MR. RICHARD H. RAMBERG (BUSINESS MANAGER)
- **Authorized official phone:** (601) 798-8003

## Contact information

- **Practice address:** 1000 FIFTH AVE, PICAYUNE, MS 39466-3214
- **Practice address phone:** (601) 798-8003
- **Practice address fax:** (601) 798-6050
- **Mailing address:** 1000 FIFTH AVE, PICAYUNE, MS 39466-3214
- **Mailing address phone:** (601) 798-8003
- **Mailing address fax:** (601) 798-6050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09015114 | — | MS |