Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT4539 | MS |
NPI | 1073840500 |
---|---|
Provider Name | Andrea Tennessee Mcphail |
First Address | Ridgeland, MS 39157 |
Second Address | Ridgeland, MS 39157-2428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2009 |
Last Update Date | 04/11/2009 |