NPIMap

Organization Active NPI

Community Rehab of Greenville Inc

Doing business as Community Rehab Physical Therapy

  • Physical Therapist
  • Gulfport, MS
National Provider Identifier
1447439070
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COMMUNITY REHAB OF GREENVILLE INC
Doing business as
Community Rehab Physical Therapy
Practice address
11010 David St
Gulfport, MS 39503-3481
Phone
(228) 832-8327
Fax
(228) 832-8328
NPI assigned
Oct 31, 2007
Last updated
Oct 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Melanie L Fayard, PTNPI 1437375060
Title
Owner/Manager
Phone
(228) 832-8327

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

11010 David St
Gulfport, MS 39503-3481

Mailing address

11010 David St
Gulfport, MS 39503-3481
Phone (228) 832-8327

Other practice location 1

4387 Leisure Time Dr
Diamondhead, MS 39525-3242
Phone (228) 255-3533

Other names 1

  • Community Rehab Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040726000846 MS Part B Supplier - Clinic/Group Practice 8123014412 Receives reassigned benefits from 7 practitioners
Practice locations: Diamondhead, MS; Gulfport, MS
O20170605003003 AL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8123014412 Receives reassigned benefits from 1 practitioner
Practice locations: Mobile, AL

National Provider Directory

National Provider Directory
Tax ID family
Community Rehab of Greenville Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9948 Airport Blvd
Ste 2
Mobile, AL 36608
Phone (251) 631-3607

4387 Leisure Time Dr
Diamondhead, MS 39525
Phone (228) 255-3533

11010 David St
Gulfport, MS 39503
Phone (228) 832-8327

11010 David St
#A
Gulfport, MS 39503
Phone (228) 832-8327

2160 E Pass Rd
Ste E
Gulfport, MS 39507
Phone (228) 604-1136

1171 Ocean Springs Rd
Ocean Springs, MS 39564
Phone (228) 875-4000

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1447439070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11010 DAVID ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033481",
            "telephone_number": "228-832-8327",
            "fax_number": "228-832-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 DAVID ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033481",
            "telephone_number": "228-832-8327",
            "fax_number": "228-832-8328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4387 Leisure Time Dr",
            "address_purpose": "LOCATION",
            "city": "Diamondhead",
            "state": "MS",
            "postal_code": "395253242",
            "country_code": "US",
            "telephone_number": "228-255-3533",
            "fax_number": "228-255-3536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY REHAB OF GREENVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "FAYARD",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "228-832-8327",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Rehab Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Rehab Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.

Verify at the official NPI Registry.