Individual
MR. JOHN S PETRIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5699 GETWELL RD, BUILDING E, SUITE 2, SOUTHAVEN, MS 38672-7312
(662) 349-6712
Mailing address
2385 APPLETON DR, SOUTHAVEN, MS 38672-7105
(662) 449-8280
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3548
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT3548
PT LICENSE: MISSISSIPPI
MS
Enumeration date
05/20/2010
Last updated
05/20/2010
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