Guy Christopher Hannibal, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1678 Issued in MS

Practice address

111 Colony Crossing Way Ste 200
Madison, MS 39110-6873

Phone

(601) 203-3869

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1386792810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6890",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477190890",
            "telephone_number": "812-491-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLONY CROSSING WAY STE 200",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106873",
            "telephone_number": "601-203-3869"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2939 Old Canton Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164211",
            "country_code": "US",
            "telephone_number": "601-203-3706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNIBAL",
        "first_name": "GUY",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT1678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08501240",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Madison, MS
• Providers in Madison, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; 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.