Basic Information
| Provider Information | |||||||||
| NPI: | 1497859029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATSON | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | DUNCAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 HALL ST | ||||||||
| Address2: | |||||||||
| City: | WIGGINS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395772105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019285511 | ||||||||
| FaxNumber: | 6019286110 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 HALL ST | ||||||||
| Address2: | |||||||||
| City: | WIGGINS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395772105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019285511 | ||||||||
| FaxNumber: | 6019286110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | PT2024 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00123057 | 05 | MS | MEDICAID |