Organization
RIVER CITY REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A. DOMINO PTA (PTA)
(662) 335-8332
Entity
Organization
Contact information
Practice address
1707 SOUTH COLORADO SUITE A, GREENVILLE, MS 38703
(662) 335-8332
(662) 335-8852
Mailing address
1707 SOUTH COLORADO SUITE A, GREENVILLE, MS 38703
(662) 335-8332
(662) 335-8852
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015486
—
MS
Enumeration date
01/16/2019
Last updated
01/16/2019
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