Provider Demographics
NPI:1366774143
Name:ACHIEVEMENT REHABILITATION AND PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:ACHIEVEMENT REHABILITATION AND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-898-1888
Mailing Address - Street 1:PO BOX 3188
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-3188
Mailing Address - Country:US
Mailing Address - Phone:601-898-1888
Mailing Address - Fax:601-898-1880
Practice Address - Street 1:676 S PEAR ORCHARD RD
Practice Address - Street 2:SUITE D
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4227
Practice Address - Country:US
Practice Address - Phone:601-898-1888
Practice Address - Fax:601-898-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty