Provider Demographics
NPI:1386421402
Name:MCCULLUM, AMBER GAIL (PT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:GAIL
Last Name:MCCULLUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2010 HIGHPOINTE DR APT 171
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2924
Mailing Address - Country:US
Mailing Address - Phone:601-580-7925
Mailing Address - Fax:
Practice Address - Street 1:512 HARMONY RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2632
Practice Address - Country:US
Practice Address - Phone:601-750-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology