# PRO PT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pro Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629343124
- **Authorized official:** CORY LEE LPTA (OWNER)
- **Authorized official phone:** (662) 231-0280

## Contact information

- **Practice address:** 3077 HIGHWAY 371 N, MANTACHIE, MS 38855-7274
- **Practice address phone:** (662) 282-4949
- **Practice address fax:** (662) 282-4955
- **Mailing address:** PO BOX 205, MANTACHIE, MS 38855-0205
- **Mailing address phone:** (662) 282-4949
- **Mailing address fax:** (662) 282-4955

## Taxonomy

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

## Other

- **Enumeration date:** 03/15/2012
- **Last updated:** 06/27/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08130311 | — | MS |