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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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