Provider Demographics
NPI:1477763969
Name:NEUROLOGY ASSOCIATES OF MS PLLC
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF MS PLLC
Other - Org Name:SEASIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-762-1936
Mailing Address - Street 1:3313 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-3228
Mailing Address - Country:US
Mailing Address - Phone:228-762-1936
Mailing Address - Fax:228-762-1926
Practice Address - Street 1:3313 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3228
Practice Address - Country:US
Practice Address - Phone:228-762-1936
Practice Address - Fax:228-762-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherBCBS MS LEGACY GROUP NUMB