Provider Demographics
NPI:1245330430
Name:RATIFF, PRESTON DESHAWN III (PT)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:DESHAWN
Last Name:RATIFF
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CHERRY ST
Mailing Address - Street 2:APT. 3-D
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4141
Mailing Address - Country:US
Mailing Address - Phone:662-374-1686
Mailing Address - Fax:662-624-4876
Practice Address - Street 1:1015 LEE DR
Practice Address - Street 2:SUITE 1 B
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-3698
Practice Address - Country:US
Practice Address - Phone:662-624-2466
Practice Address - Fax:662-624-4876
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist