Organization
FOUNTAIN OF YOUTH REHAB, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MCNAIR DPT (PHYSICAL THERAPIST)
(601) 966-1014
Entity
Organization
Contact information
Practice address
5260 CEDAR PARK DR STE E2, JACKSON, MS 39206-4131
(601) 966-1014
(866) 598-2650
Mailing address
127 S ROACH ST APT 1004, JACKSON, MS 39201-2916
(601) 966-1014
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/07/2022
Last updated
10/10/2022
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