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General NPI Number Information
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NPI Number | 1689067456
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Entity Type | Organization
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Legal Business Name | DRAGON PEDIATRIC THERAPY
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 11845 RIVER ESTATES CIR
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City | BILOXI
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State | MS
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Zip | 39532-8603
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Country | US
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Telephone | 601-916-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 11845 RIVER ESTATES CIR
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City | BILOXI
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State | MS
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Zip | 39532-8603
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Country | US
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Telephone | 601-916-6090
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | KALYN M DRAGON
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Credential | DPT
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Telephone | 601-916-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT4690
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License Number State | MS
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