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General NPI Number Information
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NPI Number | 1891102315
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 65 EARLY GROVE AVE
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City | EUPORA
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State | MS
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Zip | 39744-6002
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Country | US
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Telephone | 662-258-3332
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Fax | 662-258-3356
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Provider Business Mailing Address
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Address Line | 65 EARLY GROVE AVE
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City | EUPORA
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State | MS
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Zip | 39744-6002
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Country | US
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Telephone | 662-258-3332
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Fax | 662-258-3356
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSE A DORROH
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Credential |
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Telephone | 662-258-3332
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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 | 7877945
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License Number State | MS
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