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General NPI Number Information
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NPI Number | 1952614414
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Entity Type | Organization
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Legal Business Name | MEDICOMP PHYSICAL THERAPY RIDGELAND, INC.
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 665 S PEAR ORCHARD RD SUITE 114
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 601-956-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 665 S PEAR ORCHARD RD SUITE 114
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 601-956-1211
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSEPH S MCNULTY III
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Credential |
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Telephone | 601-849-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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 | MS
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