Active NPI
Marquis Stevenson
- Physical Therapy Assistant
- McComb, MS
National Provider Identifier
1124232293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA2176
- Practice address
- 206 Maryland Ave
McComb, MS 39648-3926 - Phone
- (601) 250-4815
- Fax
- (601) 250-6859
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA2176 | MS | Primary |
Addresses
Primary practice location
206 Maryland Ave
McComb, MS 39648-3926
Mailing address
112 Lakes Dr S
Oxford, MS 38655-9213
Phone (601) 250-4815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA2176 | MS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124232293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 LAKES DR S",
"city": "OXFORD",
"state": "MS",
"postal_code": "386559213",
"telephone_number": "601-250-4815",
"fax_number": "601-250-6859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 MARYLAND AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396483926",
"telephone_number": "601-250-4815",
"fax_number": "601-250-6859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "MARQUIS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MS",
"license": "PTA2176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.