Organization
PREMIER REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRANCE D NICKENS PT (OWNER)
(601) 636-6019
Entity
Organization
Contact information
Practice address
500 WEST COUNTYLINE RD, TOUGALOO, MS 39174
(601) 636-6019
(601) 661-8457
Mailing address
PO BOX 16569, JACKSON, MS 39236-6569
(601) 636-6019
(601) 661-8457
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/22/2008
Last updated
12/22/2008
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