MEDICARE: MRS. MARCIA HUBBARD PASSMAN RPT

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	225100000X	Physical Therapist	PT0333	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568491231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA HUBBARD PASSMAN RPT

Provider Business Mailing Address
First Line	:	46 SGT PRENTISS DR
Second Line	:	SUITE 103
City	:	NATCHEZ
State	:	MS
Zip	:	39120-4792
Country	:	US
Telephone Number	:	601-442-9654
Fax Number	:	601-442-9790

Provider Business Practice Location Address
First Line	:	46 SGT PRENTISS DR
Second Line	:	SUITE 103
City	:	NATCHEZ
State	:	MS
Zip	:	39120-4792
Country	:	US
Telephone Number	:	601-442-9654
Fax Number	:	601-442-9790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/09/2008

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