NPIMap

Organization Active NPI

Keith Vuncannon & Brad Stephenson PTRS Caring Hands Rehab

  • Physical Therapy Clinic/Center
  • Iuka, MS
National Provider Identifier
1063559755
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT3039 Issued in MS
Legal business name
KEITH VUNCANNON & BRAD STEPHENSON PTRS CARING HANDS REHAB
Practice address
503 Constitution Dr
Iuka, MS 38852-8201
Phone
(662) 720-7050
Fax
(662) 720-7055
NPI assigned
Jan 31, 2007
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Mr. Larry Keith Vuncannon, RPTNPI 1609913466
Title
Co Owner
Phone
(662) 424-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT3039 MS Primary

Addresses

Primary practice location

503 Constitution Dr
Iuka, MS 38852-8201

Mailing address

503 Constitution Dr
Iuka, MS 38852-8201
Phone (662) 424-9500

Other identifiers 1

IdentifierTypeStateIssuer
09015370MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1063559755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CONSTITUTION DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388528201",
            "telephone_number": "662-424-9500",
            "fax_number": "662-424-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 CONSTITUTION DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388528201",
            "telephone_number": "662-720-7050",
            "fax_number": "662-720-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH VUNCANNON & BRAD STEPHENSON PTRS CARING HANDS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "VUNCANNON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "662-424-9500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MS",
            "license": "PT3039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015370",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Iuka, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.