Healthcare Provider Details

I. General information

NPI: 1336291749
Provider Name (Legal Business Name): FREEMAN PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901A MISSION 66
VICKSBURG MS
39180-3711
US

IV. Provider business mailing address

205 PLANTATION DR
VICKSBURG MS
39183-8795
US

V. Phone/Fax

Practice location:
  • Phone: 601-638-6723
  • Fax: 601-638-4979
Mailing address:
  • Phone: 601-638-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0703
License Number StateMS

VIII. Authorized Official

Name: MR. DAVID RON FREEMAN
Title or Position: OWNER
Credential: PT
Phone: 601-638-6723