Healthcare Provider Details

I. General information

NPI: 1437986742
Provider Name (Legal Business Name): ACCESSIBLE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 GALAXIE DR STE 106
JACKSON MS
39206-4354
US

IV. Provider business mailing address

4780 I 55 N STE 100
JACKSON MS
39211-5583
US

V. Phone/Fax

Practice location:
  • Phone: 662-714-3122
  • Fax: 662-714-3124
Mailing address:
  • Phone: 662-714-3122
  • Fax: 662-714-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LYNN WINDHAM JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 406-253-9498