Individual
MICHAEL CHAD BAGWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 S MARKET ST, CHARLESTON, MS 38921-2236
(662) 760-7117
Mailing address
201 S MARKET ST, CHARLESTON, MS 38921-2236
(662) 760-7117
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 4035
MS
Other
Enumeration date
06/15/2009
Last updated
06/16/2011
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