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General NPI Number Information
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NPI Number | 1013454065
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Entity Type | Organization
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Legal Business Name | ALLY THERAPY SPECIALISTS, LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 100 W MAIN ST
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City | SENATOBIA
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State | MS
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Zip | 38668-2115
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Country | US
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Telephone | 662-288-1170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | SENATOBIA
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State | MS
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Zip | 38668-0022
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Country | US
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Telephone | 662-288-1170
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KELVIN MOORE
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Credential |
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Telephone | 662-288-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OT2229
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License Number State | MS
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