Healthcare Provider Details

I. General information

NPI: 1023934288
Provider Name (Legal Business Name): MACY R WEICKS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 AIR PARK RD
TUPELO MS
38801-7022
US

IV. Provider business mailing address

600 AIR PARK RD
TUPELO MS
38801-7022
US

V. Phone/Fax

Practice location:
  • Phone: 662-842-2100
  • Fax: 662-842-2105
Mailing address:
  • Phone: 662-842-2100
  • Fax: 662-842-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7341
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: