Basic Information
| Provider Information | |||||||||
| NPI: | 1437878774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MSK GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PARKWAY | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012591673 | ||||||||
| FaxNumber: | 9012597637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1582 GREEN T ROAD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HERNANDO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012591600 | ||||||||
| FaxNumber: | 9012591698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | RUSCITTO | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9016413000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MSK GROUP, PC | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.