| Organization Name: | PRO PT |
| NPI Number: | 1629343124 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORY LEE (OWNER) |
| Mailing Address: | 3104 Countryside Dr Belden |
| State: | MS US |
| Postal Code: | 388268640 |
| Phone Number: | 6622310280 |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2012 |
| NPI Last Update Date: | 04/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | PTA4312 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |