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Organization
METAMORPHOSIS REHABILITATION, LLC
Active
Organization
METAMORPHOSIS REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYNA LAQUISHA BURKS PH.D. (OWNER/SENIOR CLINICIAN)
(601) 978-0804
Entity
Organization
Contact information
Practice address
5170 SUNNYVALE DR, JACKSON, MS 39211-4845
(601) 978-0804
Mailing address
5170 SUNNYVALE DR, JACKSON, MS 39211-4845
(601) 978-0804
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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