Provider Demographics
NPI:1538473368
Name:PHYSICAL THERAPY PROFESSIONALS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSPT
Authorized Official - Phone:228-769-0112
Mailing Address - Street 1:P.O. BOX 1661
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-1661
Mailing Address - Country:US
Mailing Address - Phone:228-769-0112
Mailing Address - Fax:228-769-0199
Practice Address - Street 1:926 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567
Practice Address - Country:US
Practice Address - Phone:228-769-0112
Practice Address - Fax:228-769-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3068225100000X
MS261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7172960001Medicare NSC