Healthcare Provider Details

I. General information

NPI: 1508085317
Provider Name (Legal Business Name): E EUREE KNIGHT LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

42 JENKINS RD
MOSELLE MS
39459-9585
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 800-517-6935
Mailing address:
  • Phone: 601-584-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1667
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: