# SPROUT PEDIATRIC THERAPY, LLC

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

## Provider details

- **NPI number:** 1770060964
- **Authorized official:** MRS. EMILY R CUSTER MS,PT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (601) 831-2360

## Contact information

- **Practice address:** 108 SERENITY WAY, MADISON, MS 39110-6992
- **Practice address phone:** (601) 831-2360
- **Practice address fax:** (601) 510-9735
- **Mailing address:** 108 SERENITY WAY, MADISON, MS 39110-6992
- **Mailing address phone:** (601) 831-2360
- **Mailing address fax:** (601) 510-9735

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT3255 | MS | Yes |
| 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