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General NPI Number Information
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NPI Number | 1992941165
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Entity Type | Organization
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Legal Business Name | CHR OF BOONEVILLE, INC.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 2405D E CHAMBERS DR
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City | BOONEVILLE
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State | MS
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Zip | 38829-8927
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Country | US
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Telephone | 662-720-7050
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Fax | 662-720-7055
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Provider Business Mailing Address
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Address Line | 2405D E CHAMBERS DR
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City | BOONEVILLE
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State | MS
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Zip | 38829-8927
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Country | US
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Telephone | 662-720-7050
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Fax | 662-720-7055
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / CLINIC OWNER
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Name | MR. BRADLEY JEFF STEPHENSON
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Credential | PT
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Telephone | 662-720-7050
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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 | PT3039
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License Number State | MS
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