Active NPI
Corey White, PTA
- Physical Therapy Assistant
- Jackson, MS
National Provider Identifier
1225396252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA4900
- Practice address
- 1190 N State St
PT Department
Jackson, MS 39202-2413 - Phone
- (601) 968-1148
- Fax
- (601) 968-1337
- NPI assigned
- Apr 27, 2012
- Sex
- Male
- Sole proprietor
- No
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 | PTA4900 | MS | Primary |
Addresses
Primary practice location
1190 N State St
PT Department
Jackson, MS 39202-2413
Mailing address
1190 N State St
PT Department
Jackson, MS 39202-2413
Phone (601) 968-1148
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 |
|---|---|---|---|
| PTA4900 | MS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335484800000",
"number": "1225396252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1190 N STATE ST",
"address_2": "PT DEPARTMENT",
"city": "JACKSON",
"state": "MS",
"postal_code": "392022413",
"telephone_number": "601-968-1148",
"fax_number": "601-968-1337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1190 N STATE ST",
"address_2": "PT DEPARTMENT",
"city": "JACKSON",
"state": "MS",
"postal_code": "392022413",
"telephone_number": "601-968-1148",
"fax_number": "601-968-1337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "COREY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-27",
"last_updated": "2012-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MS",
"license": "PTA4900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.