Provider Demographics
NPI:1952793309
Name:HEAD TO TOE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HEAD TO TOE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-624-5929
Mailing Address - Street 1:665 S PEAR ORCHARD RD STE 114
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4859
Mailing Address - Country:US
Mailing Address - Phone:769-235-6788
Mailing Address - Fax:769-235-6763
Practice Address - Street 1:665 S PEAR ORCHARD RD STE 114
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4859
Practice Address - Country:US
Practice Address - Phone:769-235-6788
Practice Address - Fax:769-235-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MSPT5617261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02606739Medicaid