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General NPI Number Information
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NPI Number | 1518177971
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Entity Type | Organization
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Legal Business Name | CAPITOL PHYSICAL THERAPY, PA
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 2648 RIDGEWOOD RD SUITE A
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City | JACKSON
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State | MS
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Zip | 39216-4903
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Country | US
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Telephone | 601-366-1456
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Fax | 601-366-1448
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Provider Business Mailing Address
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Address Line | 5888 RIDGEWOOD RD STE B
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City | JACKSON
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State | MS
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Zip | 39211-2644
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Country | US
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Telephone | 601-978-1798
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Fax | 601-978-1799
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES BENFORD
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Credential | P.T.
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Telephone | 601-978-1798
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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 | PT0223
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License Number State | MS
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