Provider Demographics
NPI:1861967010
Name:GPTRS II
Entity type:Organization
Organization Name:GPTRS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-898-4324
Mailing Address - Street 1:128 BYRAM BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9636
Mailing Address - Country:US
Mailing Address - Phone:601-502-1194
Mailing Address - Fax:
Practice Address - Street 1:128 BYRAM BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9636
Practice Address - Country:US
Practice Address - Phone:601-502-1194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty