Provider Demographics
NPI:1801968318
Name:PROFESSIONAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:PROFESSIONAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-234-8559
Mailing Address - Street 1:2304 JACKSON AVE W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5416
Mailing Address - Country:US
Mailing Address - Phone:662-234-8559
Mailing Address - Fax:662-234-7923
Practice Address - Street 1:2304 JACKSON AVE W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5416
Practice Address - Country:US
Practice Address - Phone:662-234-8559
Practice Address - Fax:662-234-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9015705Medicaid
MSC02601Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER