Organization
SOG PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LUSTER (CEO)
(662) 767-4200
Entity
Organization
Contact information
Practice address
1211 S GLOSTER ST STE C, TUPELO, MS 38801-6535
(662) 767-4200
(767) 420-4662
Mailing address
1211 S GLOSTER ST, TUPELO, MS 38801-6546
(662) 432-1523
(662) 432-1528
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2019
Last updated
09/03/2024
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