# PEDIATRIC REHABILITATION AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669785580
- **Authorized official:** THEA E. JACK (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (912) 713-0277

## Contact information

- **Practice address:** 106 OGLETHORPE PROFESSIONAL CT, SUITE A, SAVANNAH, GA 31406-3695
- **Practice address phone:** (912) 351-4793
- **Practice address fax:** (888) 429-3741
- **Mailing address:** 10 MALL CT STE B, SAVANNAH, GA 31406-3691
- **Mailing address phone:** (912) 351-4793
- **Mailing address fax:** (888) 429-3741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | PT 009479 | GA | Yes |
| 225X00000X | Occupational Therapist | OT004895 | GA | — |
| 225XP0200X | Pediatric Occupational Therapist | OT002973 | GA | — |

## Other

- **Enumeration date:** 07/20/2010
- **Last updated:** 07/31/2020