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General NPI Number Information
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NPI Number | 1366886970
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Entity Type | Individual
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Provider Name | LATOYA CARSON PLUMMER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 3179 MALLETT RD STE D
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City | DIBERVILLE
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State | MS
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Zip | 39540-9302
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Country | US
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Telephone | 228-392-4710
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Fax |
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Provider Business Mailing Address
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Address Line | 17223 COVENTRY ESTATES BLVD
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City | DIBERVILLE
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State | MS
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Zip | 39540-3317
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Country | US
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Telephone | 228-596-1630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT5030
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License Number State | MS
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