Basic Information
| Provider Information | |||||||||
| NPI: | 1013213594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RELIANT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 SUMMIT GRV | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390477384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019069052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3825 HIGHWAY 80 E | ||||||||
| Address2: | |||||||||
| City: | PEARL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392084232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7697774400 | ||||||||
| FaxNumber: | 7697774401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2011 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | ADAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6019069052 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 02823259 | 05 | MS | MEDICAID |