Healthcare Provider Details

I. General information

NPI: 1336291467
Provider Name (Legal Business Name): PHYSICAL THERAPY WORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 S LIBERTY ST
CANTON MS
39046
US

IV. Provider business mailing address

3091 S LIBERTY ST
CANTON MS
39046
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-3131
  • Fax: 601-859-1101
Mailing address:
  • Phone: 601-859-3131
  • Fax: 601-859-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1300
License Number StateMS

VIII. Authorized Official

Name: MS. M E NANCE
Title or Position: PRESIDENT PT
Credential: PT
Phone: 601-859-3131