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General NPI Number Information
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NPI Number | 1699867812
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Entity Type | Individual
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Provider Name | WADE HAMPTON GASTON IV PT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 1201 HIGHWAY 49 S SUITE 2
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City | RICHLAND
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State | MS
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Zip | 39218-9425
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Country | US
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Telephone | 769-233-8844
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Fax | 769-251-1825
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Provider Business Mailing Address
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Address Line | 2416 HIGHWAY 45 N
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City | COLUMBUS
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State | MS
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Zip | 39705-1320
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Country | US
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Telephone | 662-327-6705
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Fax | 662-327-6760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT2964
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License Number State | MS
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