Basic Information
| Provider Information | |||||||||
| NPI: | 1780646943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | ATC, LAT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 KEYSTONE DR | ||||||||
| Address2: | |||||||||
| City: | PETAL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394652524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015453810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1145 HIGHWAY 42 | ||||||||
| Address2: | |||||||||
| City: | PETAL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394659740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015440500 | ||||||||
| FaxNumber: | 6015440505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT0175 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.