# PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH THERAPY

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

## Provider details

- **NPI number:** 1922838994
- **Authorized official:** CORTNEY DEARMAN (OWNER)
- **Authorized official phone:** (601) 480-8025

## Contact information

- **Practice address:** 3419 WISCONSIN AVE, VICKSBURG, MS 39180-5330
- **Practice address phone:** (601) 629-0505
- **Mailing address:** 321 POPPYSEED LN, RAYMOND, MS 39154-2100
- **Mailing address phone:** (601) 480-8025

## Taxonomy

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

## Other

- **Enumeration date:** 08/05/2024
- **Last updated:** 12/03/2025