Provider Demographics
NPI:1528739984
Name:CARDIO-PULMONARY REHABILITATION (C.P.R.)
Entity type:Organization
Organization Name:CARDIO-PULMONARY REHABILITATION (C.P.R.)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FANTROY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:228-235-6015
Mailing Address - Street 1:4361 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-5635
Mailing Address - Country:US
Mailing Address - Phone:228-235-6015
Mailing Address - Fax:
Practice Address - Street 1:11 N WATER ST STE 10290
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-5010
Practice Address - Country:US
Practice Address - Phone:228-235-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty