Organization
RESTORATION REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIE SHERON BURT PT (OWNER)
(601) 366-6171
Entity
Organization
Contact information
Practice address
6501 DOGWOOD VIEW PKWY, SUITE C, JACKSON, MS 39213-7857
(601) 366-6171
Mailing address
6501 DOGWOOD VIEW PKWY, SUITE C, JACKSON, MS 39213-7857
(601) 366-6171
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1297
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06229265
—
MS
01
—
64094670
EIN
MS
Enumeration date
06/19/2006
Last updated
08/22/2020
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