Provider Demographics
NPI:1235215708
Name:LAUREL PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:LAUREL PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:SOUTH MISSISSIPPI PHYSICAL THERAPY-BAY SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2447
Mailing Address - Country:US
Mailing Address - Phone:713-297-7000
Mailing Address - Fax:713-297-7090
Practice Address - Street 1:14 N THIRD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9798
Practice Address - Country:US
Practice Address - Phone:601-764-4125
Practice Address - Fax:601-764-3930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL PHYSICAL THERAPY LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS256549Medicare Oscar/Certification