Provider Demographics
NPI:1922838994
Name:PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH THERAPY
Entity type:Organization
Organization Name:PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-750-0155
Mailing Address - Street 1:504 RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8670
Mailing Address - Country:US
Mailing Address - Phone:601-750-0155
Mailing Address - Fax:
Practice Address - Street 1:504 RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-8670
Practice Address - Country:US
Practice Address - Phone:601-750-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty