Individual
CODY O'NEAL BROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 PECAN DR, COLUMBIA, MS 39429-2600
(601) 731-5717
(601) 633-0082
Mailing address
599C STEED RD, RIDGELAND, MS 39157-1707
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA7008
MS
Other
Enumeration date
03/28/2022
Last updated
06/22/2022
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