Organization
2083 THERAPY, LLC
Active
Other names
2083 Therapy of Brandon
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH S MCNULTY IV (CEO)
(601) 849-6440
Entity
Organization
Contact information
Practice address
1392 W GOVERNMENT ST STE C, BRANDON, MS 39042-3049
(601) 824-8814
Mailing address
1392 W GOVERNMENT ST STE C, BRANDON, MS 39042-3049
(601) 824-8814
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1109164
BUSINESS LICENSE
—
Enumeration date
11/14/2017
Last updated
11/14/2017
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