Provider Demographics
NPI:1558459594
Name:NATCHEZ REHAB & SPORTS SPECIALISTS
Entity Type:Organization
Organization Name:NATCHEZ REHAB & SPORTS SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:KATI
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:601-446-8764
Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-446-8764
Mailing Address - Fax:601-446-8745
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:SUITE 8
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-446-8764
Practice Address - Fax:601-446-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty