Individual
MR. RICK A PSONAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
777 LAKELAND DR, JACKSON, MS 39216-4611
(601) 984-6525
(601) 984-5485
Mailing address
PO BOX 3188, JACKSON, MS 39207-3188
(601) 984-6525
(601) 984-5485
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO1452
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02901340
—
MS
01
—
CPO1452
CERIFICATION
MS
Enumeration date
10/12/2006
Last updated
02/14/2008
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