Provider Demographics
NPI:1831260454
Name:PROFESSIONAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:PROFESSIONAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:601-693-6700
Mailing Address - Street 1:1001 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4458
Mailing Address - Country:US
Mailing Address - Phone:601-693-6700
Mailing Address - Fax:601-639-6699
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4458
Practice Address - Country:US
Practice Address - Phone:601-693-6700
Practice Address - Fax:601-639-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9016307Medicaid
MS9016307Medicaid