Individual
MR. STEPHEN GRANT NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
140 EUREKA STREET, TAYLORSVILLE, MS 39168
(601) 785-9292
Mailing address
641 HOY RD, LAUREL, MS 39443-0912
(601) 433-5926
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3150
MS
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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