NPIMap

Organization Active NPI

Exceed Physical Therapy, LLC

  • Physical Therapist
  • Gulfport, MS
National Provider Identifier
1023508348
Registry record updated May 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
EXCEED PHYSICAL THERAPY, LLC
Practice address
12261 Highway 49 Ste 1
Gulfport, MS 39503-2976
Phone
(228) 861-4218
NPI assigned
May 11, 2018
Last updated
May 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chad Blalack
Title
Manager
Phone
(228) 860-9676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

12261 Highway 49 Ste 1
Gulfport, MS 39503-2976

Mailing address

3 Bayou PL
Gulfport, MS 39503-6202
Phone (228) 861-4218

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20180910002531 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8123378338 Receives reassigned benefits from 15 practitioners
Practice locations: Gulfport, MS
O20191211003103 MS Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8123378338 Practice locations: Gulfport, MS
O20250905000723 MS DME Supplier - Independently-Practicing Occupational Therapist 8123378338 Practice locations: Gulfport, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023508348. Details of each certification follow.

  • CCN 256617 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 256617

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
EXCEED PHYSICAL THERAPY, LLC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 9, 2020
Last certification
Oct 9, 2020
Ownership / control type
Proprietary
Facility address
12261 Highway 49, Suite 1
Gulfport, MS 39503

National Provider Directory

National Provider Directory

Locations

12261 Highway 49
Ste 1
Gulfport, MS 39503
Phone (228) 265-7185

Practitioners & affiliated clinicians

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 80

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525996800000",
    "number": "1023508348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BAYOU PL",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395036202",
            "telephone_number": "228-861-4218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12261 HIGHWAY 49 STE 1",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032976",
            "telephone_number": "228-861-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEED PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-11",
        "last_updated": "2018-05-11",
        "status": "A",
        "authorized_official_last_name": "BLALACK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "228-860-9676"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.