| NPI | 1740622539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WAYNE GRANTHAM Physical Therapist/Owner 601-906-3718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MS PT3612) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2016-07-26 |