Healthcare Provider Details

I. General information

NPI: 1114793189
Provider Name (Legal Business Name): MSK GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 SOUTHCREST PKWY STE 105
SOUTHAVEN MS
38671-4851
US

IV. Provider business mailing address

6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5754
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2506
  • Fax: 901-261-2590
Mailing address:
  • Phone: 901-641-3000
  • Fax: 901-701-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHRIS RUSCITTO
Title or Position: CFO
Credential:
Phone: 901-641-3000