Organization
S. KEITH HOLTON, PLLC
Active
Other names
MAGNOLIA OUTPATIENT REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOLTON (OFFICE MANAGER)
(662) 243-1097
Entity
Organization
Contact information
Practice address
2205 5TH ST N, COLUMBUS, MS 39705-2211
(662) 243-1097
(662) 243-1095
Mailing address
2205 5TH ST N, COLUMBUS, MS 39705-2211
(662) 243-1097
(662) 243-1095
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015582
—
MS
01
—
212664314B
BCBS OF MS PROV NUMBER
MS
Enumeration date
10/24/2006
Last updated
11/02/2011
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