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General NPI Number Information
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NPI Number | 1366774143
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Entity Type | Organization
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Legal Business Name | ACHIEVEMENT REHABILITATION AND PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 676 S PEAR ORCHARD RD SUITE D
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City | RIDGELAND
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State | MS
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Zip | 39157-4227
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Country | US
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Telephone | 601-898-1888
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Fax | 601-898-1880
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Provider Business Mailing Address
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Address Line | PO BOX 3188
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City | RIDGELAND
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State | MS
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Zip | 39158-3188
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Country | US
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Telephone | 601-898-1888
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Fax | 601-898-1880
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | TERRENCE D NICKENS
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Credential | DPT
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Telephone | 601-898-1888
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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 | PT3573
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License Number State | MS
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