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Organization
TRI STATE REHABILITATION INC
Active
Organization
TRI STATE REHABILITATION INC
Active
Other names
Valdosta Pediatric Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHRYN REAGAN CCC-SLP (SPEECH AND LANGUAGE PATHOLOGIST)
(229) 253-8500
Entity
Organization
Contact information
Practice address
202 W PARK AVE, VALDOSTA, GA 31602-2507
(229) 253-8500
(229) 253-8522
Mailing address
202 W PARK AVE, VALDOSTA, GA 31602-2507
(229) 253-8500
(229) 253-8522
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
005367
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52171814
BLUE CROSS BLUE SHIELD
GA
Enumeration date
01/18/2007
Last updated
07/16/2007
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