Healthcare Provider Details

I. General information

NPI: 1548405236
Provider Name (Legal Business Name): VISIONS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 ROBINSON RD
JACKSON MS
39204
US

IV. Provider business mailing address

4700 ROBINSON RD
JACKSON MS
39204
US

V. Phone/Fax

Practice location:
  • Phone: 601-636-6019
  • Fax: 601-661-8457
Mailing address:
  • Phone: 601-636-6019
  • Fax: 601-661-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3192
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberS3299
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPT3192
License Number StateMS

VIII. Authorized Official

Name: MARCUS T HARRIS
Title or Position: OWNER
Credential: PT
Phone: 601-636-6019