Organization
PROFESSIONAL REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE RUEDA PT. (PHYSICAL THERAPIST/PRESIDENT)
(901) 438-8799
Entity
Organization
Contact information
Practice address
6231 RAVENWOOD CV, HORN LAKE, MS 38637-2588
(901) 438-8799
(662) 280-3324
Mailing address
6231 RAVENWOOD CV, HORN LAKE, MS 38637-2588
(901) 438-8799
(662) 280-3324
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4344
TN
Other
Enumeration date
08/30/2006
Last updated
08/22/2020
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