Sog Physical Therapy | |
1211 S Gloster St Ste C Tupelo MS 38801-6535 | |
(662) 767-4200 | |
(767) 420-4662 |
Full Name | Sog Physical Therapy |
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Speciality | Clinic/Center |
Location | 1211 S Gloster St Ste C, Tupelo, Mississippi |
Authorized Official Name and Position | Thomas Luster (CEO) |
Authorized Official Contact | 6627674200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Sog Physical Therapy 1211 S Gloster St Tupelo MS 38801-6546 Ph: (662) 432-1523 | Sog Physical Therapy 1211 S Gloster St Ste C Tupelo MS 38801-6535 Ph: (662) 767-4200 |
NPI Number | 1902361660 |
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Provider Enumeration Date | 02/07/2019 |
Last Update Date | 09/03/2024 |
Medicare PECOS PAC ID | 1850627209 |
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Medicare Enrollment ID | O20190724000229 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902361660 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Gabrielle Chiniche |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1003842758 PECOS PAC ID: 9830108455 Enrollment ID: I20060824000450 |
Provider Name | Paul A Kosko |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1871722173 PECOS PAC ID: 3375697766 Enrollment ID: I20090819000788 |
Provider Name | Donna B Buchanan |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1093157570 PECOS PAC ID: 3870919434 Enrollment ID: I20200813002565 |
Provider Name | Christy L Flynn |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1932543055 PECOS PAC ID: 1456779560 Enrollment ID: I20200921003194 |
Provider Name | Collin Sanders |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1720693245 PECOS PAC ID: 8527488659 Enrollment ID: I20201012001497 |
Provider Name | James Ryan Wall |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1962071050 PECOS PAC ID: 9335540988 Enrollment ID: I20210702000945 |
Provider Name | Caley O'callaghan Speck |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1003341462 PECOS PAC ID: 6608265194 Enrollment ID: I20211123001609 |
Provider Name | Joseph Cason Collins |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1184353237 PECOS PAC ID: 0648659953 Enrollment ID: I20220616001413 |
Provider Name | Rachel Marie Windham |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1376272278 PECOS PAC ID: 4284013947 Enrollment ID: I20220627001532 |
Provider Name | Michael Scott Childers |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1144061706 PECOS PAC ID: 8022555374 Enrollment ID: I20240805000233 |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-2386 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |