Provider Demographics
NPI:1497948152
Name:STARKVILLE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:STARKVILLE PHYSICAL THERAPY, INC.
Other - Org Name:STARKVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-615-1870
Mailing Address - Street 1:100B4 GT THAMES DRIVE
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-8836
Mailing Address - Country:US
Mailing Address - Phone:662-615-1870
Mailing Address - Fax:662-615-1871
Practice Address - Street 1:100B4 GT THAMES DRIVE
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-8836
Practice Address - Country:US
Practice Address - Phone:662-615-1870
Practice Address - Fax:662-615-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT 1169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty