Provider Demographics
NPI:1700641628
Name:EXCEED PHYSICAL THERAPY OF TUPELO
Entity Type:Organization
Organization Name:EXCEED PHYSICAL THERAPY OF TUPELO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:662-207-3849
Mailing Address - Street 1:1649 N COLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-397-7456
Mailing Address - Fax:
Practice Address - Street 1:1649 N COLEY ROAD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-397-7456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEED OF MS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty