Basic Information
| Provider Information | |||||||||
| NPI: | 1083962732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATTEN | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7213 SIWELL ROAD | ||||||||
| Address2: | |||||||||
| City: | BYRAM | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018290505 | ||||||||
| FaxNumber: | 6018290506 | ||||||||
| Practice Location | |||||||||
| Address1: | 7213 S SIWELL RD | ||||||||
| Address2: | |||||||||
| City: | BYRAM | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392729776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018290505 | ||||||||
| FaxNumber: | 6018290506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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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 | 225100000X | PT4228 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.