Healthcare Provider Details

I. General information

NPI: 1295943959
Provider Name (Legal Business Name): FAITH ANITA HADLEY KT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N VALLEY FALLS RD
JACKSON MS
39212-4514
US

IV. Provider business mailing address

1003 N VALLEY FALLS RD
JACKSON MS
39212-4514
US

V. Phone/Fax

Practice location:
  • Phone: 601-466-1916
  • Fax:
Mailing address:
  • Phone: 601-466-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: