Healthcare Provider Details

I. General information

NPI: 1831253319
Provider Name (Legal Business Name): BEVERLY ATHEN PARKS RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LOCUST HILL RD
BELDEN MS
38826-9379
US

IV. Provider business mailing address

511 LOCUST HILL RD
BELDEN MS
38826-9376
US

V. Phone/Fax

Practice location:
  • Phone: 662-322-6186
  • Fax:
Mailing address:
  • Phone: 662-842-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number704
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: