Healthcare Provider Details

I. General information

NPI: 1124332135
Provider Name (Legal Business Name): ANNA CLAIRE JEFCOAT LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 HIGHWAY 9 N
BRUCE MS
38915
US

IV. Provider business mailing address

175 MAGNOLIA SOUTH CIR
PONTOTOC MS
38863-2703
US

V. Phone/Fax

Practice location:
  • Phone: 662-412-5220
  • Fax:
Mailing address:
  • Phone: 662-419-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4438
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: