Healthcare Provider Details

I. General information

NPI: 1386978450
Provider Name (Legal Business Name): PRINCIPAL THERAPIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 N LAMAR BLVD STE 109
OXFORD MS
38655-3204
US

IV. Provider business mailing address

428 NORTH LAMAR, SUITE 109
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-0850
  • Fax: 662-513-0073
Mailing address:
  • Phone: 662-513-0850
  • Fax: 662-513-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIEN BENNETT HUBBARD
Title or Position: CEO
Credential:
Phone: 662-513-0850