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General NPI Number Information
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NPI Number | 1396903209
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Entity Type | Organization
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Legal Business Name | SPECIALIZED THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 16 OFFICE PARK DR SUITE 21
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City | HATTIESBURG
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State | MS
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Zip | 39402-6020
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Country | US
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Telephone | 601-296-9191
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Fax | 601-296-9190
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Provider Business Mailing Address
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Address Line | 16 OFFICE PARK DR SUITE 21
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City | HATTIESBURG
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State | MS
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Zip | 39402-6020
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Country | US
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Telephone | 601-296-9191
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Fax | 601-296-9190
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MANDY K BRUNSON
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Credential |
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Telephone | 601-296-9191
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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 | PT0932
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT0493
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License Number State | MS
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