Provider Demographics
NPI:1962135392
Name:CALHOUN, CARLA MCKENZIE (PT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MCKENZIE
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119-5539
Mailing Address - Country:US
Mailing Address - Phone:601-750-9538
Mailing Address - Fax:
Practice Address - Street 1:529 LAKE ST STE C
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2226
Practice Address - Country:US
Practice Address - Phone:601-574-7388
Practice Address - Fax:601-894-3676
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist