Provider Demographics
NPI:1619351517
Name:FREEMAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FREEMAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RON
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-529-9193
Mailing Address - Street 1:1990 S FRONTAGE RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5232
Mailing Address - Country:US
Mailing Address - Phone:601-738-5714
Mailing Address - Fax:855-753-9454
Practice Address - Street 1:1990 S FRONTAGE RD
Practice Address - Street 2:SUITE J
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5232
Practice Address - Country:US
Practice Address - Phone:601-738-5714
Practice Address - Fax:855-753-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0703261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy