Healthcare Provider Details

I. General information

NPI: 1649512260
Provider Name (Legal Business Name): RECOVERY SPORTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NAVAJO CIR
CLINTON MS
39056-3110
US

IV. Provider business mailing address

143 NAVAJO CIR
CLINTON MS
39056-3110
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-3030
  • Fax:
Mailing address:
  • Phone: 601-720-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. JIMMY RANEY
Title or Position: CO-OWNER
Credential:
Phone: 601-720-3030