Provider Demographics
NPI:1235154048
Name:GOLDEN TRIANGLE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:GOLDEN TRIANGLE PHYSICAL THERAPY INC.
Other - Org Name:RED HILLS ORTHOPEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-773-3700
Mailing Address - Street 1:17045 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2754
Mailing Address - Country:US
Mailing Address - Phone:662-773-3700
Mailing Address - Fax:662-773-3727
Practice Address - Street 1:17045 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2754
Practice Address - Country:US
Practice Address - Phone:662-773-3700
Practice Address - Fax:662-773-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1026225100000X
225100000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9014488Medicaid
MS256536Medicare Oscar/Certification