Provider Demographics
NPI:1851792352
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-536-4096
Mailing Address - Street 1:7900 AIRWAYS BLVD
Mailing Address - Street 2:BUILDING A SUITE 2
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4113
Mailing Address - Country:US
Mailing Address - Phone:662-536-4096
Mailing Address - Fax:662-536-4099
Practice Address - Street 1:7900 AIRWAYS BLVD
Practice Address - Street 2:BUILDING A SUITE 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4113
Practice Address - Country:US
Practice Address - Phone:662-536-4096
Practice Address - Fax:662-536-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA5483261QP2000X
TNPTA5777261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy