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General NPI Number Information
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NPI Number | 1851448708
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Entity Type | Organization
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Legal Business Name | CUSTOMIZED PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 FOX CHASE DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-2575
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Country | US
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Telephone | 601-408-8700
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Fax | 601-264-2285
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Provider Business Mailing Address
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Address Line | 702 HILLENDALE DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-2618
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Country | US
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Telephone | 601-408-8700
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Fax | 601-264-2285
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA M RIMES
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Credential | P.T.
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Telephone | 601-408-8700
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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 | PT 1137
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License Number State | MS
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