Healthcare Provider Details

I. General information

NPI: 1972361822
Provider Name (Legal Business Name): JADA CAROL MIMS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINDSOR PLACE REHAB 81 WINDSOR BLVD
COLUMBUS MS
39702
US

IV. Provider business mailing address

PO BOX 522
WINONA MS
38967-0522
US

V. Phone/Fax

Practice location:
  • Phone: 662-241-5518
  • Fax:
Mailing address:
  • Phone: 662-310-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7472
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: