Provider Demographics
NPI:1093822280
Name:DESOTO THERAPY, INC.
Entity Type:Organization
Organization Name:DESOTO THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:901-412-4516
Mailing Address - Street 1:391 SOUTHCREST CIR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6730
Mailing Address - Country:US
Mailing Address - Phone:662-772-5925
Mailing Address - Fax:662-772-5928
Practice Address - Street 1:391 SOUTHCREST CIR
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6730
Practice Address - Country:US
Practice Address - Phone:662-772-5925
Practice Address - Fax:662-772-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS897162302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization