Organization
HATTIESBURG CLINIC PA
Active
Other names
Petal Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN N BATSON (EXECUTIVE DIRECTOR)
(601) 264-6000
Entity
Organization
Contact information
Practice address
206 CORINTH RD, PETAL, MS 39465-2883
(601) 583-9464
(601) 583-9465
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02181291
—
MS
Enumeration date
10/06/2006
Last updated
02/23/2021
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