# MAGNOLIA HEALTHCARE REHABILITATION SERVICES

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

## Provider details

- **NPI number:** 1679668784
- **Authorized official:** MR. BARRY L. MONDAY (BILLING ADMIN)
- **Authorized official phone:** (601) 296-2552

## Contact information

- **Practice address:** 1 LINCOLN PKWY, SUITE104, HATTIESBURG, MS 39402-3262
- **Practice address phone:** (601) 268-3292
- **Practice address fax:** (601) 296-2554
- **Mailing address:** PO BOX 16325, HATTIESBURG, MS 39404-6325
- **Mailing address phone:** (601) 296-2552
- **Mailing address fax:** (601) 296-2554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01537007 | — | MS |
| 01 | — | DA5495 | RAILROAD MEDICARE | MS |