Premier Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PREMIER PHYSICAL THERAPY, LLC

Practice address

558 1St South St
Woodville, MS 39669-3777

Phone

(601) 888-7944

Fax

(601) 888-7687

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gary Russell Johnson, PTNPI 1285794107

Title

Owner

Phone

(601) 888-7944

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 2

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

• Gary Russell Johnson, PT

  • Physical Therapist
  • Woodville, MS
  • NPI 1285794107
  Medicare reassignment NPD Authorized official
• Lori K Taylor, OT

  • Specialist
  • Woodville, MS
  • NPI 1255429924
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691712000000",
    "number": "1053523209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 1ST SOUTH ST",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396693777",
            "telephone_number": "601-888-7944",
            "fax_number": "601-888-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 1ST SOUTH ST",
            "city": "WOODVILLE",
            "state": "MS",
            "postal_code": "396693777",
            "telephone_number": "601-888-7944",
            "fax_number": "601-888-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-888-7944",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016186",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKenzie Healthcare Solutions
• Mississippi State Department of Health
• Tobie Delton Moore, DDS
• Louis J Owens, M.D.
• Premier Pharmaceutical Services, LLC
• Alicia Freeman Randall, LCSW
• Shelley Walters Redhead, PHARMACIST
• Pradeep Kumar Selvaraj, M.D
• Megan Sistrunk
• Roslyn Jill Smith, PHARMD

• Physical Therapist in Woodville, MS
• Providers in Woodville, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.