Basic Information
| Provider Information | |||||||||
| NPI: | 1063664357 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PYEATT | ||||||||
| FirstName: | ELLEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1369 AUBURN DR SW | ||||||||
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| City: | BOGUE CHITTO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396298262 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MILLS ST | ||||||||
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| City: | BROOKHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396012521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA3533 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.