Provider Demographics
NPI:1154605087
Name:BAPTIST PHYSICAL THERAPHY & SPORTSCARE-PEARL
Entity type:Organization
Organization Name:BAPTIST PHYSICAL THERAPHY & SPORTSCARE-PEARL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-944-1717
Mailing Address - Street 1:309 AIRPORT RD S STE B
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6678
Mailing Address - Country:US
Mailing Address - Phone:601-939-8155
Mailing Address - Fax:601-939-8396
Practice Address - Street 1:309 AIRPORT RD S STE B
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6678
Practice Address - Country:US
Practice Address - Phone:601-939-8155
Practice Address - Fax:601-939-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty