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General NPI Number Information
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NPI Number | 1801309778
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Entity Type | Organization
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Legal Business Name | 2083 THERAPY, LLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 1392 W GOVERNMENT ST STE C
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City | BRANDON
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State | MS
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Zip | 39042-3049
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Country | US
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Telephone | 601-824-8814
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Fax |
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Provider Business Mailing Address
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Address Line | 1392 W GOVERNMENT ST STE C
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City | BRANDON
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State | MS
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Zip | 39042-3049
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Country | US
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Telephone | 601-824-8814
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH S MCNULTY IV
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Credential |
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Telephone | 601-849-6440
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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 |
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License Number State |
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