# SOUTHEAST REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Poplar Bluff Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588848618
- **Authorized official:** KYLEE ELLSWORTH (OFFICE MANAGER)
- **Authorized official phone:** (573) 712-2280

## Contact information

- **Practice address:** 3999 HWY PP, SUITE 2, POPLAR BLUFF, MO 63901
- **Practice address phone:** (573) 712-2280
- **Practice address fax:** (573) 778-9589
- **Mailing address:** PO BOX 3, POPLAR BLUFF, MO 63902-0003
- **Mailing address phone:** (573) 712-2280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2007
- **Last updated:** 07/17/2015