Healthcare Provider Details

I. General information

NPI: 1457497349
Provider Name (Legal Business Name): TONYA G MCLENDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W RAILROAD AVE N
CRYSTAL SPRINGS MS
39059-2154
US

IV. Provider business mailing address

1012 CRYSTAL HILL LN
CRYSTAL SPRINGS MS
39059-4400
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-8707
  • Fax: 601-892-7614
Mailing address:
  • Phone: 601-892-8707
  • Fax: 601-892-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1263
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: