=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295943959
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAITH ANITA HADLEY KT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 N VALLEY FALLS RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39212-4514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-466-1916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 N VALLEY FALLS RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39212-4514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-466-1916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 226300000X
-----------------------------------------------------
Taxonomy Name | Kinesiotherapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------