=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336291467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY WORKS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3091 S LIBERTY ST
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-859-3131
-----------------------------------------------------
Fax | 601-859-1101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3091 S LIBERTY ST
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-859-3131
-----------------------------------------------------
Fax | 601-859-1101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT PT
-----------------------------------------------------
Name | MS. M E NANCE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 601-859-3131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT1300
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------