Healthcare Provider Details

I. General information

NPI: 1992199509
Provider Name (Legal Business Name): QUINCY HARVEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 479-968-4331
Mailing address:
  • Phone: 479-498-6700
  • Fax: 479-968-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5556
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: