Provider Demographics
NPI:1861522427
Name:HATTIEBURG PHYSICAL THERAPY CENTER
Entity type:Organization
Organization Name:HATTIEBURG PHYSICAL THERAPY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:601-296-0199
Mailing Address - Street 1:6068 U S HIGHWAY 98
Mailing Address - Street 2:SUITE 1196
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8883
Mailing Address - Country:US
Mailing Address - Phone:601-296-0199
Mailing Address - Fax:601-296-0189
Practice Address - Street 1:52 98 PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8603
Practice Address - Country:US
Practice Address - Phone:601-296-0199
Practice Address - Fax:601-296-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03705Medicare PIN
MSP03496Medicare UPIN