Individual
MRS. KATIE BUFORD DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
,PT, DPT
Contact information
Practice address
702 HIGHWAY 82 W, GREENWOOD, MS 38930-5069
(662) 455-5010
Mailing address
PO BOX 59, GLENDORA, MS 38928-0059
(662) 897-4835
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5061
MS
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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