Organization
SHILOH RIDGE ATHLETIC CLUB
Active
Organization
SHILOH RIDGE ATHLETIC CLUB
Active
Parent organization
TRI-VISTA REHAB INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRI-VISTA REHAB INC
Authorized official
MR. KEVIN BOUTIN (OWNER)
(662) 287-5662
Entity
Organization
Contact information
Practice address
3303 SHILOH RIDGE RD, CORINTH, MS 38834-9698
(662) 287-5662
Mailing address
PO BOX 3592, TUPELO, MS 38803-3592
(662) 287-5662
(662) 287-5662
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2009
Last updated
05/21/2009
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