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Organization
MAGNOLIA HEALTHCARE REHABILITATION SERVICES
Active
Organization
MAGNOLIA HEALTHCARE REHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY L. MONDAY (BILLING ADMIN)
(601) 296-2552
Entity
Organization
Contact information
Practice address
1 LINCOLN PKWY, SUITE104, HATTIESBURG, MS 39402-3262
(601) 268-3292
(601) 296-2554
Mailing address
PO BOX 16325, HATTIESBURG, MS 39404-6325
(601) 296-2552
(601) 296-2554
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01537007
—
MS
01
—
DA5495
RAILROAD MEDICARE
MS
Enumeration date
10/04/2006
Last updated
08/07/2011
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