# TRI-VISTA REHAB, INC

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

## Provider details

- **NPI number:** 1982799516
- **Authorized official:** MR. KEVIN TROY BOUTIN OTR (PRESIDENT)
- **Authorized official phone:** (662) 231-7304

## Contact information

- **Practice address:** 90 CLARK BLVD, A, TUPELO, MS 38804-2801
- **Practice address phone:** (662) 840-0535
- **Mailing address:** PO BOX 3592, TUPELO, MS 38803
- **Mailing address phone:** (662) 840-0535
- **Mailing address fax:** (662) 842-7915

## Taxonomy

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