Provider Demographics
NPI: | 1912372913 |
---|---|
Name: | BAPTIST PHYSICAL THERAPY AND SPORTSCARE |
Entity Type: | Organization |
Organization Name: | BAPTIST PHYSICAL THERAPY AND SPORTSCARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REHAB DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CAUSEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 601-982-2400 |
Mailing Address - Street 1: | 108 CLINTON PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | CLINTON |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 39056-4730 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 601-926-2018 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 108 CLINTON PKWY |
Practice Address - Street 2: | |
Practice Address - City: | CLINTON |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39056-4730 |
Practice Address - Country: | US |
Practice Address - Phone: | 601-926-2018 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BAPTIST HEALTH SYSTEMS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2015-12-02 |
Last Update Date: | 2015-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | PTA4868 | 282N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital |