MEDICARE: GPTRS II

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

General Provider Information

NPI Number	:	1861967010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GPTRS II

Provider Business Mailing Address
First Line	:	128 BYRAM BUSINESS CENTER DR
Second Line	:
City	:	BYRAM
State	:	MS
Zip	:	39272-9636
Country	:	US
Telephone Number	:	601-502-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 BYRAM BUSINESS CENTER DR
Second Line	:
City	:	BYRAM
State	:	MS
Zip	:	39272-9636
Country	:	US
Telephone Number	:	601-502-1194
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GREGORY H TRUSSELL
Credential	:
Telephone Number	:	601-898-4324

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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