Organization
TRI-VISTA REHAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN TROY BOUTIN OTR (PRESIDENT)
(662) 840-0535
Entity
Organization
Contact information
Practice address
3776 CROSSHAVEN DR, VESTAVIA, AL 35223-2833
(337) 886-7097
(866) 522-1008
Mailing address
PO BOX 3592, TUPELO, MS 38803-3592
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1011705
MS
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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