Organization
GRACE MYOFASCIAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA WEILENMAN SELLERS (PHYSICAL THERAPIST)
(601) 717-0910
Entity
Organization
Contact information
Practice address
3000 OLD CANTON RD STE 240, JACKSON, MS 39216-4235
(601) 717-0910
(769) 257-6382
Mailing address
3000 OLD CANTON RD STE 240, JACKSON, MS 39216-4235
(601) 717-0910
(769) 257-6382
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT3632
MS
Other
Enumeration date
01/19/2011
Last updated
07/17/2012
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