Organization
SPECIALIZED THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MANDY K BRUNSON (OFFICE MANAGER)
(601) 296-9191
Entity
Organization
Contact information
Practice address
16 OFFICE PARK DR, SUITE 21, HATTIESBURG, MS 39402-6020
(601) 296-9191
(601) 296-9190
Mailing address
16 OFFICE PARK DR, SUITE 21, HATTIESBURG, MS 39402-6020
(601) 296-9191
(601) 296-9190
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT0932
MS
225X00000X
Occupational Therapist
Primary
OT0493
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03389700
—
MS
01
—
587471053A
BLUE CROSS BLUE SHIELD
MS
01
—
670000041
MEDICARE
MS
01
—
P00062876
MEDICARE RAILROAD
MS
Enumeration date
05/28/2008
Last updated
09/11/2008
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