Healthcare Provider Details

I. General information

NPI: 1972386522
Provider Name (Legal Business Name): PHILIP A LAURENCE PT, DPT, SCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDEPENDENCE BLDG 1100
COLUMBUS MS
39710-5300
US

IV. Provider business mailing address

201 INDEPENDENCE BLDG 1100
COLUMBUS MS
39710-5300
US

V. Phone/Fax

Practice location:
  • Phone: 662-434-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: