Basic Information
| Provider Information | |||||||||
| NPI: | 1649747262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HABIB REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 3012 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381483012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342624663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1255 HILYARD ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342624663 | ||||||||
| FaxNumber: | 4582095028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | FANNY | ||||||||
| AuthorizedOfficialFirstName: | HABIB | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER/AUTH IND | ||||||||
| AuthorizedOfficialTelephone: | 7342624663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.