MEDICARE: TAYTUM MACKENZIE REID DPT

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	PT7830	MS

General Provider Information

NPI Number	:	1952132623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYTUM MACKENZIE REID DPT

Provider Business Mailing Address
First Line	:	599C STEED RD
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1707
Country	:	US
Telephone Number	:	601-308-4386
Fax Number	:

Provider Business Practice Location Address
First Line	:	803A HIGHWAY 98 BYP
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3710
Country	:	US
Telephone Number	:	601-444-0030
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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