Grace Myofascial Clinic, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT3632 Issued in MS

Legal business name

GRACE MYOFASCIAL CLINIC, LLC

Practice address

3000 Old Canton Rd Ste 240
Jackson, MS 39216-4235

Phone

(601) 717-0910

Fax

(769) 257-6382

NPI assigned

Jan 19, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Amanda Weilenman Sellers

Title

Physical Therapist

Phone

(601) 717-0910

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1457656639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 240",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164235",
            "telephone_number": "601-717-0910",
            "fax_number": "769-257-6382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 240",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164235",
            "telephone_number": "601-717-0910",
            "fax_number": "769-257-6382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MYOFASCIAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "WEILENMAN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "601-717-0910",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MS",
            "license": "PT3632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Itedrianna Goston
• Angelica Gowdy, PCMHT
• Miranda Goza, NP
• Shelby Duke Goza Jr.
• Grace & Mercy Family Medical Clinic, PLLC
• Graceful Hands Personal Care Corp
• Graceful Wellness LLC
• Gracey & Murphy Faithful Code
• Andrew Wilcox Grady, DVM
• Angela Graeber, M.D.

• Physical Therapy Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Physical Therapy Clinic/Center in Mississippi

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

Verify at the official NPI Registry.