Individual
BRENDA MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
630 S MAIN ST, WATER VALLEY, MS 38965-3468
(662) 473-5947
(601) 607-1416
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1262
MS
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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