Provider Demographics
NPI:1689244527
Name:ONLINE THERAPY SERVICES OF MISSISSIPPI, PLLC
Entity Type:Organization
Organization Name:ONLINE THERAPY SERVICES OF MISSISSIPPI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTRECE
Authorized Official - Middle Name:AFONDRE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-213-8194
Mailing Address - Street 1:7620 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8968
Mailing Address - Country:US
Mailing Address - Phone:601-213-8194
Mailing Address - Fax:
Practice Address - Street 1:7620 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8968
Practice Address - Country:US
Practice Address - Phone:601-213-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy