Organization
SPORTY SPROUTS INC
Active
Other names
Sporty Sprouts: Youth Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON EUGENE HOLMES (CEO)
(601) 850-3698
Entity
Organization
Contact information
Practice address
104 FAITH WAY, BRANDON, MS 39042-8676
(601) 850-3698
Mailing address
PO BOX 4233, BRANDON, MS 39047-4233
(601) 850-3698
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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