Healthcare Provider Details

I. General information

NPI: 1235200304
Provider Name (Legal Business Name): JOHN W HOUSTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CAMELLIA RD
CARRIERE MS
39426-7077
US

IV. Provider business mailing address

1620 HIGHWAY 11 N STE E
PICAYUNE MS
39466-2070
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-7777
  • Fax:
Mailing address:
  • Phone: 769-242-2626
  • Fax: 769-242-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1533
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: