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Organization

PEDIATRIC REHABILITATION AND WELLNESS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THEA E. JACK (OWNER/PHYSICAL THERAPIST)
(912) 713-0277
Entity
Organization

Contact information

Practice address
106 OGLETHORPE PROFESSIONAL CT, SUITE A, SAVANNAH, GA 31406-3695
(912) 351-4793
(888) 429-3741
Mailing address
10 MALL CT STE B, SAVANNAH, GA 31406-3691
(912) 351-4793
(888) 429-3741

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 009479
GA
225X00000X
Occupational Therapist
OT004895
GA
225XP0200X
Pediatric Occupational Therapist
OT002973
GA

Other

Enumeration date
07/20/2010
Last updated
07/31/2020
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