=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114072667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA FAY DOWNS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 AVIGNON DR
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-5120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-605-6777
-----------------------------------------------------
Fax | 601-605-8869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 N PERKINS ST
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-540-6897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT1676
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------