# FONDREN NIGHTINGALES PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356019954
- **Authorized official:** GREGG LEVY (OWNER)
- **Authorized official phone:** (601) 398-1492

## Contact information

- **Practice address:** 3321 N WEST ST, JACKSON, MS 39216-3039
- **Practice address phone:** (601) 398-1492
- **Mailing address:** 3321 N WEST ST, JACKSON, MS 39216-3039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2021
- **Last updated:** 08/31/2021