Organization
PRO PT
Active
Other names
Pro Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
CORY LEE LPTA (OWNER)
(662) 231-0280
Entity
Organization
Contact information
Practice address
3077 HIGHWAY 371 N, MANTACHIE, MS 38855-7274
(662) 282-4949
(662) 282-4955
Mailing address
PO BOX 205, MANTACHIE, MS 38855-0205
(662) 282-4949
(662) 282-4955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08130311
—
MS
Enumeration date
03/15/2012
Last updated
06/27/2016
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