Organization
TRI-VISTA REHAB, INC
Active
Other names
TriVista Rehab at Riverbirch Residence
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BOUTIN OTR (PRESIDENT)
(662) 840-0535
Entity
Organization
Contact information
Practice address
2554 MAIN ST, PLANTERSVILLE, MS 38862-7908
(662) 407-0301
(662) 842-7915
Mailing address
PO BOX 3592, TUPELO, MS 38803-3592
(662) 407-0301
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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