Active NPI
Brittney Gholar, DPT
- Physical Therapy Clinic/Center
- Jackson, MS
National Provider Identifier
1255860326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- PT6196
- Practice address
- 5225 Highway 18 W
Jackson, MS 39209-9446 - Phone
- (601) 487-8456
- NPI assigned
- Jun 12, 2017
- Sex
- Female
- 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 Clinic/Center | 261QP2000X | PT6196 | MS | Primary |
Addresses
Primary practice location
5225 Highway 18 W
Jackson, MS 39209-9446
Mailing address
805 Madison St Apt 202
Jackson, MS 39202-4153
Phone (601) 270-8638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231026002207 | NC | Practitioner - Physical Therapist in Private Practice | 3072889823 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6196 | MS | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497225600000",
"number": "1255860326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 MADISON ST APT 202",
"city": "JACKSON",
"state": "MS",
"postal_code": "392024153",
"telephone_number": "601-270-8638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 HIGHWAY 18 W",
"city": "JACKSON",
"state": "MS",
"postal_code": "392099446",
"telephone_number": "601-487-8456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHOLAR",
"first_name": "BRITTNEY",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "MS",
"license": "PT6196",
"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 Jun 12, 2017; 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.