Healthcare Provider Details

I. General information

NPI: 1447603386
Provider Name (Legal Business Name): ALANNA BROOKE MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AUTUMN RIDGE DR
KOSCIUSKO MS
39090-3242
US

IV. Provider business mailing address

4109 HIGHWAY 98 W
SUMMIT MS
39666-9132
US

V. Phone/Fax

Practice location:
  • Phone: 662-289-7044
  • Fax:
Mailing address:
  • Phone: 601-276-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5935
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: