Provider Demographics
NPI:1578255907
Name:NASH, MATHILDA LAIL (DPT)
Entity Type:Individual
Prefix:
First Name:MATHILDA
Middle Name:LAIL
Last Name:NASH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MATHILDA
Other - Middle Name:ANN
Other - Last Name:LAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:262 KING RD
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-8835
Mailing Address - Country:US
Mailing Address - Phone:662-255-7238
Mailing Address - Fax:
Practice Address - Street 1:262 KING RD
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-8835
Practice Address - Country:US
Practice Address - Phone:662-225-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist