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Organization
METAMORPHOSIS REHABILITATION, LLC
Active
Organization
METAMORPHOSIS REHABILITATION, LLC
Active
Other names
Metamorphosis Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYNA LAQUISHA BURKS PH. D. (OWNER/SENIOR CLINICIAN)
(909) 570-1198
Entity
Organization
Contact information
Practice address
5170 SUNNYVALE DR, JACKSON, MS 39211-4845
(909) 570-1198
Mailing address
5170 SUNNYVALE DR, JACKSON, MS 39211-4845
(909) 570-1198
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
251E00000X
Home Health Agency
—
—
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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