Provider Demographics
NPI:1538124052
Name:HIGHTOWER, CAMELLIA K (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAMELLIA
Middle Name:K
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N THIRD ST STE B
Mailing Address - Street 2:PO BOX 1542
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-9798
Mailing Address - Country:US
Mailing Address - Phone:601-764-4125
Mailing Address - Fax:601-764-4125
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:601-764-4125
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist