# METAMORPHOSIS REHABILITATION, LLC

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

## Provider details

- **NPI number:** 1285478214
- **Authorized official:** MYNA LAQUISHA BURKS PH.D. (OWNER/SENIOR CLINICIAN)
- **Authorized official phone:** (601) 978-0804

## Contact information

- **Practice address:** 5170 SUNNYVALE DR, JACKSON, MS 39211-4845
- **Practice address phone:** (601) 978-0804
- **Mailing address:** 5170 SUNNYVALE DR, JACKSON, MS 39211-4845
- **Mailing address phone:** (601) 978-0804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | Yes |
| 235Z00000X | Speech-Language Pathologist | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/24/2024
- **Last updated:** 06/24/2024