Medicomp Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MEDICOMP PHYSICAL THERAPY, LLC

Practice address

26049 W Main St
West Point, MS 39773-2760

Phone

(662) 391-4000

Fax

(662) 391-4002

NPI assigned

Apr 15, 2020

Organization subpart

No

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

Authorized official

Name

Jessica Brooke Pettit, PTNPI 1003202953

Title

Ceo

Phone

(662) 391-4000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Brooke Pettit, DPT, PT

  • Physical Therapist
  • West Point, MS
  • NPI 1003202953
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1023637402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26049 W MAIN ST",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397732760",
            "telephone_number": "662-391-4000",
            "fax_number": "662-391-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26049 W MAIN ST",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397732760",
            "telephone_number": "662-391-4000",
            "fax_number": "662-391-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICOMP PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-391-4000",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandi Carline McKinney, COTA/L
• Katelyn Caroll McLeroy
• Sheena McMorris, MS
• Savanna McPhail
• Tashika L McQueen, MSCE
• Medicomp, Inc
• Nancy Heyer Miles, R.PH.
• Nita Miller, MED
• Shannon Miller, BA
• Susan K Miller, LPTA

• Physical Therapist in West Point, MS
• Providers in West Point, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.