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Organization
PARAGON REHAB, LLC
Active
Organization
PARAGON REHAB, LLC
Active
Parent organization
CLC OF LIBERTY, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLC OF LIBERTY, LLC
Authorized official
SALLY MCCOY (ADMINISTRATOR)
(601) 657-1000
Entity
Organization
Contact information
Practice address
323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
(601) 657-1000
(601) 657-9121
Mailing address
323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
(601) 657-1000
(601) 657-9121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 0958
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230121
—
MS
Enumeration date
03/22/2011
Last updated
03/22/2011
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