Provider Demographics
NPI:1932196912
Name:NIX, MICHAEL T (RPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:NIX
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N HAYDEN ST
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-3639
Mailing Address - Country:US
Mailing Address - Phone:662-247-4446
Mailing Address - Fax:662-247-2772
Practice Address - Street 1:401 N HAYDEN ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3639
Practice Address - Country:US
Practice Address - Phone:662-247-4446
Practice Address - Fax:662-247-2772
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01873070Medicaid