Basic Information
| Provider Information | |||||||||
| NPI: | 1013401017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLENDON SPIVEY | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | LATAY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 N WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390743315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015070148 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1129 HIGHWAY 35 S STE 2 | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390748829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014691001 | ||||||||
| FaxNumber: | 6014691009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT5296 | MS | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.