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Organization
TRI-VISTA REHAB, INC
Active
Organization
TRI-VISTA REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN TROY BOUTIN OTR (PRESIDENT)
(662) 231-7304
Entity
Organization
Contact information
Practice address
90 CLARK BLVD, A, TUPELO, MS 38804-2801
(662) 840-0535
Mailing address
PO BOX 3592, TUPELO, MS 38803
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
10/03/2006
Last updated
09/27/2016
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