Individual
MICHAEL WADE BASKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
501 E MAIN ST, LOUISVILLE, MS 39339-2737
(662) 773-3700
Mailing address
501 E MAIN ST, LOUISVILLE, MS 39339-2737
(662) 773-3700
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1026
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9014488
—
MS
Enumeration date
01/30/2007
Last updated
07/09/2007
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