Healthcare Provider Details

I. General information

NPI: 1356412803
Provider Name (Legal Business Name): FIRST PLACE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 BROAD ST
COLUMBIA MS
39429-3038
US

IV. Provider business mailing address

433 BROAD ST
COLUMBIA MS
39429-3038
US

V. Phone/Fax

Practice location:
  • Phone: 601-444-0030
  • Fax: 601-444-0033
Mailing address:
  • Phone: 601-444-0030
  • Fax: 601-444-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0549
License Number StateMS

VIII. Authorized Official

Name: CARROLL EDWARD BROWN
Title or Position: OWNER THERAPIST
Credential: PT OCS
Phone: 601-444-0030