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Organization
SPROUT PEDIATRIC THERAPY, LLC
Active
Organization
SPROUT PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILY R CUSTER MS,PT (OWNER/PHYSICAL THERAPIST)
(601) 831-2360
Entity
Organization
Contact information
Practice address
108 SERENITY WAY, MADISON, MS 39110-6992
(601) 831-2360
(601) 510-9735
Mailing address
108 SERENITY WAY, MADISON, MS 39110-6992
(601) 831-2360
(601) 510-9735
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3255
MS
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/20/2018
Last updated
06/06/2026
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