Provider Demographics
NPI:1942586383
Name:SPORTS THERAPY CENTER
Entity Type:Organization
Organization Name:SPORTS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-980-2997
Mailing Address - Street 1:207 W JACKSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2355
Mailing Address - Country:US
Mailing Address - Phone:601-898-9503
Mailing Address - Fax:601-898-4682
Practice Address - Street 1:207 W JACKSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2355
Practice Address - Country:US
Practice Address - Phone:601-898-9503
Practice Address - Fax:601-898-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty