Healthcare Provider Details

I. General information

NPI: 1801968318
Provider Name (Legal Business Name): PROFESSIONAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 JACKSON AVE W
OXFORD MS
38655-5416
US

IV. Provider business mailing address

2304 JACKSON AVE W
OXFORD MS
38655-5416
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-8559
  • Fax: 662-234-7923
Mailing address:
  • Phone: 662-234-8559
  • Fax: 662-234-7923

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

VIII. Authorized Official

Name: MICHAEL FULTON
Title or Position: OWNER PRESIDENT
Credential: P.T.
Phone: 662-234-8559