Sprout Pediatric Therapy, LLC

NPI #1770060964 in Madison, Mississippi

Provider Information

NPI Number: 1770060964
Entity Type: Organization
Organization Name: Sprout Pediatric Therapy, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jul 20, 2018
Last Updated: Jul 20, 2018

Practice Location

Address: 108 SERENITY WAY
City: Madison
State: Mississippi
ZIP Code: 39110-6992
Phone: (601) 831-2360

Authorized Official

Name: MRS. EMILY R CUSTER, MS,PT
Title: OWNER/PHYSICAL THERAPIST
Phone: (601) 831-2360

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Speech-Language Pathologist	235Z00000X
Physical Therapist	225100000X	Primary

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