Organization
AT HOME PHYSICAL REHABILITATION GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROQUE FLESTADO ESTIPONA JR. PT, DPT (CEO/ADMINISTRATOR)
(901) 461-5787
Entity
Organization
Contact information
Practice address
856 WILLOW TREE CIRCLE, CORDOVA, TN 38018
(901) 794-7988
(901) 794-7877
Mailing address
856 WILLOW TREE CIRCLE, CORDOVA, TN 38018
(901) 794-7988
(901) 794-7877
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
251E00000X
Home Health Agency
—
—
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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