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General NPI Number Information
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NPI Number | 1952338667
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Entity Type | Organization
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Legal Business Name | CLARKSDALE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 100 EAST LEE
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City | CLARKSDALE
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State | MS
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Zip | 38614
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Country | US
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Telephone | 662-627-6734
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Fax | 662-627-6737
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Provider Business Mailing Address
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Address Line | 50 S MAIN ST
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City | WATER VALLEY
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State | MS
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Zip | 38965-2946
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Country | US
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Telephone | 662-473-3400
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Fax | 662-473-4389
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Authorized Official
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Title or Position | SECRETARY/ TREASURER
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Name | MR. THOMAS L WINDHAM
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Credential |
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Telephone | 662-473-3400
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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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