Basic Information
| Provider Information | |||||||||
| NPI: | 1023280468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 E BAY ST | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396522815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017830220 | ||||||||
| FaxNumber: | 6017830222 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 E BAY ST | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396522815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017830220 | ||||||||
| FaxNumber: | 6017830222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARKER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6018337317 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 05686296 | 05 | MS | MEDICAID |