Organization
RIDGELAND SPORTS MEDICINE & REHAB, INC
Active
Organization
RIDGELAND SPORTS MEDICINE & REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE C ELLISON P. T. (PRESIDENT/OWNER)
(601) 956-1211
Entity
Organization
Contact information
Practice address
665 S PEAR ORCHARD RD, SUITE 114, RIDGELAND, MS 39157-4861
(601) 956-1211
(601) 956-2282
Mailing address
665 S PEAR ORCHARD RD, SUITE 114, RIDGELAND, MS 39157-4861
(601) 956-1211
(601) 956-2282
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
MS PT0747
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5965404
AETNA
MS
Enumeration date
10/05/2006
Last updated
08/22/2020
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