=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669749735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANATOMIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 98 PLACE BLVD
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-8676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-579-9555
-----------------------------------------------------
Fax | 601-271-7980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 98 PLACE BLVD
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-8676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-579-9555
-----------------------------------------------------
Fax | 601-271-7980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GATEWAY PROGRAM DIRECTOR
-----------------------------------------------------
Name | MISS JESSICA LEE ARMSTRONG
-----------------------------------------------------
Credential | ACSM-HFS
-----------------------------------------------------
Telephone | 601-579-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Y00000X
-----------------------------------------------------
Taxonomy Name | Clinical Exercise Physiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------