| NPI | 1710039656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN H. HERRICK Billing 662-843-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT1494) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT0355) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2010-11-01 |