Provider Demographics
NPI:1083962732
Name:HATTEN, MARIE W (DPT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:W
Last Name:HATTEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 SIWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272
Mailing Address - Country:US
Mailing Address - Phone:601-829-0505
Mailing Address - Fax:601-829-0506
Practice Address - Street 1:7213 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-829-0505
Practice Address - Fax:601-829-0506
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist