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General NPI Number Information
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NPI Number | 1619351517
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Entity Type | Organization
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Legal Business Name | FREEMAN PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 1990 S FRONTAGE RD SUITE J
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City | VICKSBURG
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State | MS
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Zip | 39180-5232
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Country | US
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Telephone | 601-738-5714
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Fax | 855-753-9454
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Provider Business Mailing Address
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Address Line | 1990 S FRONTAGE RD SUITE J
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City | VICKSBURG
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State | MS
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Zip | 39180-5232
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Country | US
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Telephone | 601-738-5714
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Fax | 855-753-9454
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DAVID RON FREEMAN
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Credential | PT
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Telephone | 601-529-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT0703
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License Number State | MS
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