Healthcare Provider Details

I. General information

NPI: 1316707946
Provider Name (Legal Business Name): REGAIN PELVIC PHYSICAL THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 24TH PL STE A
MERIDIAN MS
39305-1686
US

IV. Provider business mailing address

4715 24TH PL STE A
MERIDIAN MS
39305-1686
US

V. Phone/Fax

Practice location:
  • Phone: 601-531-3599
  • Fax:
Mailing address:
  • Phone: 601-531-3599
  • Fax: 601-531-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISHA MICHALLE MASSEY
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential:
Phone: 601-481-5815