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General NPI Number Information
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NPI Number | 1962972364
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Entity Type | Individual
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Provider Name | BYRON ANTHONY STUTTS PT
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Gender | Male
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 90A CLARK ST
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City | TUPELO
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State | MS
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Zip | 38804-4812
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Country | US
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Telephone | 662-840-0535
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Fax | 662-842-7915
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Provider Business Mailing Address
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Address Line | 28 SONADA LN
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City | PETAL
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State | MS
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Zip | 39465-9667
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Country | US
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Telephone | 601-606-9788
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Fax | 662-842-7915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT1522
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License Number State | MS
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