Provider Demographics
NPI:1912372913
Name:BAPTIST PHYSICAL THERAPY AND SPORTSCARE
Entity type:Organization
Organization Name:BAPTIST PHYSICAL THERAPY AND SPORTSCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-982-2400
Mailing Address - Street 1:108 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4730
Mailing Address - Country:US
Mailing Address - Phone:601-926-2018
Mailing Address - Fax:
Practice Address - Street 1:108 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-926-2018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4868282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital