Individual
STACI P ANDING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
525 BROOKMAN DR, BROOKHAVEN, MS 39601-2326
(601) 833-2330
Mailing address
104 NOBLE DR, BROOKHAVEN, MS 39601-3624
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1700
MS
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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