Organization
TRI-VISTA REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN TROY BOUTIN OTR (PRESIDENT)
(662) 840-0535
Entity
Organization
Contact information
Practice address
90A CLARK BLVD, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Mailing address
90A CLARK BLVD, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
PT4554
MS
Other
Enumeration date
08/07/2012
Last updated
09/26/2012
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