Organization
MISSISSIPPI SPORT AND SPINE REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD BARKER AT (ATHLETIC TRAINER)
(662) 680-5216
Entity
Organization
Contact information
Practice address
1743 CLIFF GOOKIN BLVD, TUPELO, MS 38801-6723
(662) 680-5216
(662) 680-5217
Mailing address
1743 CLIFF GOOKIN BLVD, TUPELO, MS 38801-6723
(662) 680-5216
(662) 680-5217
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015485
—
MS
Enumeration date
11/10/2006
Last updated
10/20/2008
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