Provider Demographics
NPI:1538315726
Name:ALINSUB, ROY A (PT)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:ALINSUB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 HIGHWAY 51 N
Mailing Address - Street 2:21-101
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7940
Mailing Address - Country:US
Mailing Address - Phone:901-340-2526
Mailing Address - Fax:
Practice Address - Street 1:4740 HIGHWAY 51 N
Practice Address - Street 2:21-101
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7940
Practice Address - Country:US
Practice Address - Phone:901-340-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6326225100000X
MS4031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist