Provider Demographics
NPI:1932362324
Name:FAMILY PHYSICAL THERAPY OF SOUTH MS LLC
Entity type:Organization
Organization Name:FAMILY PHYSICAL THERAPY OF SOUTH MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINIC DIRECTOR PHYSICAL THER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:228-863-4080
Mailing Address - Street 1:100-A LA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-863-4080
Mailing Address - Fax:228-863-4014
Practice Address - Street 1:100-A LA ROSA RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560
Practice Address - Country:US
Practice Address - Phone:228-863-4080
Practice Address - Fax:228-863-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT31282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00356883Medicaid
MSQ24754Medicare PIN