Provider Demographics
NPI:1609383207
Name:BILLINGTON, PEYTON CHRISTIAN (PTA)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:CHRISTIAN
Last Name:BILLINGTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2459
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6200
Mailing Address - Country:US
Mailing Address - Phone:662-380-5030
Mailing Address - Fax:
Practice Address - Street 1:169 HIGHWAY 6 E STE 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6902
Practice Address - Country:US
Practice Address - Phone:662-380-5030
Practice Address - Fax:662-380-5620
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6243225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPTA6243OtherTHERAPY LICENSE