# SOG PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1902361660
- **Authorized official:** THOMAS LUSTER (CEO)
- **Authorized official phone:** (662) 767-4200

## Contact information

- **Practice address:** 1211 S GLOSTER ST STE C, TUPELO, MS 38801-6535
- **Practice address phone:** (662) 767-4200
- **Practice address fax:** (767) 420-4662
- **Mailing address:** 1211 S GLOSTER ST, TUPELO, MS 38801-6546
- **Mailing address phone:** (662) 432-1523
- **Mailing address fax:** (662) 432-1528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/07/2019
- **Last updated:** 09/03/2024