Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5615 | MS |
NPI | 1083023675 |
---|---|
Provider Name | Ms. Jerrica Thomas |
First Address | Germantown, TN 38138-2205 |
Second Address | Southaven, MS 38671-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |