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NPI Code Detail

MEDICARE: WADE HAMPTON GASTON IV PT

MEDICARE: WADE HAMPTON GASTON IV PT
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
1225100000XPhysical TherapistPT2964MS

General Provider Information

NPI Number : 1699867812
Entity Type Code : Individual
Provider Name (Legal Business Name) : WADE HAMPTON GASTON IV PT
Provider Business Mailing Address
First Line : 2416 HIGHWAY 45 N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-1320
Country : US
Telephone Number : 662-327-6705
Fax Number : 662-327-6760
Provider Business Practice Location Address
First Line : 1201 HIGHWAY 49 S
Second Line : SUITE 2
City : RICHLAND
State : MS
Zip : 39218-9425
Country : US
Telephone Number : 769-233-8844
Fax Number : 769-251-1825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 11/09/2016

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Directions to “ WADE HAMPTON GASTON IV PT” Practice Location

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