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General NPI Number Information
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NPI Number | 1023383569
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Entity Type | Organization
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Legal Business Name | SOUTHERN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 7 WILLOW BEND DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-8552
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Country | US
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Telephone | 601-336-8287
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Fax |
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Provider Business Mailing Address
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Address Line | 7 WILLOW BEND DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-8552
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Country | US
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Telephone | 601-336-8287
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANICE T. TREGRE
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Credential | DPT
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Telephone | 601-336-8287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3956
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License Number State | MS
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