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Organization
PROFESSIONAL REHAB ASSOCIATES
Active
Organization
PROFESSIONAL REHAB ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD WILSON DPT, ATC (PRESIDENT)
(601) 250-5455
Entity
Organization
Contact information
Practice address
1301 A HARRISON AVE, MCCOMB, MS 39648
(601) 250-5455
(601) 250-5453
Mailing address
1301 A HARRISON AVE, MCCOMB, MS 39648
(601) 250-5455
(601) 250-5453
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
—
01209052
—
MS
Enumeration date
01/31/2011
Last updated
06/04/2019
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