| NPI | 1083607220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA L ASHFORD Manager 662-335-8332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT1045) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT0169) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2025-07-07 |