Healthcare Provider Details
I. General information
NPI: 1912303447
Provider Name (Legal Business Name): MSK GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/11/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7580 CLARINGTON CV
SOUTHAVEN MS
38671
US
IV. Provider business mailing address
6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5742
US
V. Phone/Fax
- Phone: 901-641-3000
- Fax: 901-259-1698
- Phone: 901-725-8347
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | 22398 |
| License Number State | MS |
VIII. Authorized Official
Name:
CHRISTOPHER
RUSCITTO
Title or Position: CFO
Credential:
Phone: 901-641-3000