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
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