MEDICARE: POPLAR SPRINGS PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1417340399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPLAR SPRINGS PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4711 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-990-7185
Fax Number	:	601-483-5569

Provider Business Practice Location Address
First Line	:	4711 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-990-7185
Fax Number	:	601-483-5569

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAZEE AMEIR AHMAD
Credential	:	M.D.
Telephone Number	:	601-917-0810

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/16/2015

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