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General NPI Number Information
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NPI Number | 1932965522
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Entity Type | Organization
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Legal Business Name | BIENVILLE THERAPY, LLC
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Dates
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Enumeration Date | 02/22/2024
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 3615 HOSPITAL ST STE B
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City | PASCAGOULA
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State | MS
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Zip | 39581-4112
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Country | US
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Telephone | 228-230-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 E LAKE BLVD STE 301
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City | VANCLEAVE
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State | MS
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Zip | 39565-6771
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Country | US
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Telephone | 228-230-2663
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Fax | 228-206-6398
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Authorized Official
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Title or Position | CEO
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Name | LEE BOND
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Credential |
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Telephone | 228-230-2663
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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 |
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License Number State |
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