Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Physical Therapy Occupational Therapy Speech Therapy

Organization Physical Therapist · NPI 1922838994

Physical Therapy Occupational Therapy Speech Therapy is a Physical Therapist in Vicksburg, Mississippi. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

3419 Wisconsin Ave
Vicksburg, MS 39180-5330
Phone: (601) 629-0505
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1922838994
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cortney Dearman — Owner · (601) 480-8025
NPI enumeratedAugust 5, 2024
Last updated in NPPESDecember 3, 2025
Certification dateDecember 3, 2025
Mailing address321 Poppyseed Ln, Raymond, MS 39154-2100

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