| Premier Physical Therapy, Llc | |
|
558 1st South St, Woodville, MS 39669-3777 | |
| (601) 888-7944 | |
| (601) 888-7687 |
| Full Name | Premier Physical Therapy, Llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 558 1st South St, Woodville, Mississippi |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053523209 | NPI | - | NPPES |
| 09016186 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Provider Name | Gary R Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285794107 PECOS PAC ID: 2668559121 Enrollment ID: I20080408000445 |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Physical Therapy, Llc 558 1st South St, Woodville, MS 39669-3777 Ph: (601) 888-7944 | Premier Physical Therapy, Llc 558 1st South St, Woodville, MS 39669-3777 Ph: (601) 888-7944 |
Mr. Gary Russell Johnson, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 558 1st South St, Woodville, MS 39669 Phone: 601-888-7944 Fax: 601-888-4676 | |
Virginia Lewis, D.P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 558 1st South St, Woodville, MS 39669 Phone: 601-888-7944 Fax: 601-888-4767 |