Provider Demographics
NPI:1306044565
Name:THERAPY FIRST OF MCCOMB
Entity Type:Organization
Organization Name:THERAPY FIRST OF MCCOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCOLUMN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-918-9055
Mailing Address - Street 1:410 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4021
Mailing Address - Country:US
Mailing Address - Phone:601-918-9055
Mailing Address - Fax:
Practice Address - Street 1:410 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4021
Practice Address - Country:US
Practice Address - Phone:601-918-9055
Practice Address - Fax:601-371-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty