Healthcare Provider Details

I. General information

NPI: 1912351602
Provider Name (Legal Business Name): EDUCATION THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BELLE OAK LN
BRANDON MS
39042-8101
US

IV. Provider business mailing address

PO BOX 16107
JACKSON MS
39236-6107
US

V. Phone/Fax

Practice location:
  • Phone: 662-871-0549
  • Fax:
Mailing address:
  • Phone: 662-871-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateMS

VIII. Authorized Official

Name: ALVIN DALE GRIFFIN
Title or Position: OWNER/OPERATOR
Credential: COTA/L
Phone: 662-871-0549