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NPI Code Detail

MEDICARE: MRS. MALINDA C. FAYARD PT

MEDICARE: MRS. MALINDA C. FAYARD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistPT3173MS

General Provider Information

NPI Number : 1386115160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MALINDA C. FAYARD PT
Provider Business Mailing Address
First Line : 10327 SHADY PINE DR
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39565-9325
Country : US
Telephone Number : 228-547-6614
Fax Number :
Provider Business Practice Location Address
First Line : 6017 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2648
Country : US
Telephone Number : 228-547-6614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2018
Last Update Date : 12/05/2018

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