Individual
STEPHANIE GORRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 949-9110
Mailing address
PO BOX 16870, JACKSON, MS 39236-6870
(601) 944-1717
(601) 944-9780
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
PT3169
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07071069
—
MS
Enumeration date
07/20/2006
Last updated
07/08/2007
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