# PARAGON REHAB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CLC OF LIBERTY, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306145958
- **Legal business name:** CLC OF LIBERTY, LLC
- **Authorized official:** SALLY MCCOY (ADMINISTRATOR)
- **Authorized official phone:** (601) 657-1000

## Contact information

- **Practice address:** 323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
- **Practice address phone:** (601) 657-1000
- **Practice address fax:** (601) 657-9121
- **Mailing address:** 323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
- **Mailing address phone:** (601) 657-1000
- **Mailing address fax:** (601) 657-9121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT 0958 | MS | Yes |

## Other

- **Enumeration date:** 03/22/2011
- **Last updated:** 03/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00230121 | — | MS |