Provider Demographics
NPI:1568491231
Name:PASSMAN, MARCIA HUBBARD (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:HUBBARD
Last Name:PASSMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-442-9654
Mailing Address - Fax:601-442-9790
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-442-9654
Practice Address - Fax:601-442-9790
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119325Medicaid
MS0119325Medicaid
MS650000231Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER