Healthcare Provider Details

I. General information

NPI: 1760508865
Provider Name (Legal Business Name): CYNTHIA L SHIRES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 HIGHWAY 18 W
JACKSON MS
39209-9666
US

IV. Provider business mailing address

4820 HIGHWAY 18 W
JACKSON MS
39209-9666
US

V. Phone/Fax

Practice location:
  • Phone: 601-922-7022
  • Fax:
Mailing address:
  • Phone: 601-922-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0142
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: