Healthcare Provider Details

I. General information

NPI: 1558560938
Provider Name (Legal Business Name): BETTY MECHELLE PARKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY MECHELLE WILLIAMS PT

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 BEAUVOIR RD
BILOXI MS
39531-5004
US

IV. Provider business mailing address

3688 VETERANS MEMORIAL DR SUITE 300
HATTIESBURG MS
39401-8246
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-5714
  • Fax: 228-388-0017
Mailing address:
  • Phone: 601-543-0221
  • Fax: 601-543-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3223
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: