Healthcare Provider Details

I. General information

NPI: 1962239269
Provider Name (Legal Business Name): ABBY GRACE PRAYTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 PASS RD STE F
BILOXI MS
39531-2112
US

IV. Provider business mailing address

42465 HIGHWAY 195
HALEYVILLE AL
35565-7052
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-1002
  • Fax: 228-388-1006
Mailing address:
  • Phone: 256-350-1764
  • Fax: 256-355-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7538
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: