Antonio Debose

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA7521 Issued in MS

Practice address

671 Grants Ferry Rd Ste a
Flowood, MS 39232-6801

Phone

(769) 777-4400

Fax

(769) 777-4401

NPI assigned

Jul 22, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reliant, Inc.

  • Physical Therapy Clinic/Center
  • Pearl, MS
  • NPI 1013213594
  NPD

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1235967340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "671 GRANTS FERRY RD STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326801",
            "telephone_number": "769-777-4400",
            "fax_number": "769-777-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 GRANTS FERRY RD STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326801",
            "telephone_number": "769-777-4400",
            "fax_number": "769-777-4401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3825 Highway 80 E",
            "address_purpose": "LOCATION",
            "city": "Pearl",
            "state": "MS",
            "postal_code": "392084232",
            "country_code": "US",
            "telephone_number": "769-777-4400",
            "fax_number": "769-777-4401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEBOSE",
        "first_name": "ANTONIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA7521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meagan Dear, PMHNP-BC
• Amanda Canizaro Dearman, PT
• Stephanie Dearman, LCSW
• Dawn Dearmond, NNP
• Kristen Deason, NP
• Paige H. Dedmon, RN
• Raina Deer
• Defining Wellness Centers Inc.
• Ashley Nicole Delancy, LCSW
• Layson Lawler Denney, MD

• Physical Therapy Assistant in Flowood, MS
• Providers in Flowood, MS by specialty
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; 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.