MEDICARE: MRS. CAMELLIA K HIGHTOWER 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
1	225100000X	Physical Therapist	PT1160	MS

General Provider Information

NPI Number	:	1538124052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMELLIA K HIGHTOWER PT

Provider Business Mailing Address
First Line	:	14 N THIRD ST STE B
Second Line	:	PO BOX 1542
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-9798
Country	:	US
Telephone Number	:	601-764-4125
Fax Number	:	601-764-4125

Provider Business Practice Location Address
First Line	:	14 N THIRD ST
Second Line	:	SUITE B
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-9798
Country	:	US
Telephone Number	:	601-764-4125
Fax Number	:	601-764-4125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/08/2009

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