Organization
PREMIER PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY RUSSELL JOHNSON PT (OWNER)
(601) 888-7944
Entity
Organization
Contact information
Practice address
558 1ST SOUTH ST, WOODVILLE, MS 39669-3777
(601) 888-7944
(601) 888-7687
Mailing address
558 1ST SOUTH ST, WOODVILLE, MS 39669-3777
(601) 888-7944
(601) 888-7687
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016186
—
MS
Enumeration date
05/03/2007
Last updated
08/11/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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