Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA1363 | MS |
NPI | 1003197922 |
---|---|
Provider Name | Ms. Melissa Hardin Crockett |
First Address | Saltillo, MS 38866-9390 |
Second Address | Saltillo, MS 38866-9390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 06/09/2011 |