Organization
EDEN REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH J RICHE PTA (MEMBER)
(601) 573-9974
Entity
Organization
Contact information
Practice address
6100 OLD BRANDON RD, BRANDON, MS 39042-2543
(601) 933-1100
Mailing address
119 BONNE VIE DR, BRANDON, MS 39047-8789
(601) 573-9974
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
TA1991
MS
224Z00000X
Occupational Therapy Assistant
TA2342
MS
225200000X
Physical Therapy Assistant
Primary
PTA2491
MS
225200000X
Physical Therapy Assistant
PTA2698
MS
Other
Enumeration date
12/19/2010
Last updated
12/19/2010
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