NPIMap

Organization Active NPI

Fitness Clinic

  • Physical Therapist
  • Jackson, MS
National Provider Identifier
1497027775
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FITNESS CLINIC
Practice address
2219 Greenway Dr
Jackson, MS 39204-3202
Phone
(601) 983-7494
Fax
(601) 371-3993
NPI assigned
Feb 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Authorized official

Name
Ms. Barbara Marie Broadwater
Title
Executive Director
Phone
(601) 983-7494

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2219 Greenway Dr
Jackson, MS 39204-3202

Mailing address

2219 Greenway Dr
Jackson, MS 39204-3202
Phone (601) 983-7494

National Provider Directory

National Provider Directory

Locations

2219 Greenway Dr
Jackson, MS 39204
Phone (601) 983-7494

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1497027775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 GREENWAY DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043202",
            "telephone_number": "601-983-7494",
            "fax_number": "601-371-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 GREENWAY DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043202",
            "telephone_number": "601-983-7494",
            "fax_number": "601-371-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "BROADWATER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-983-7494",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "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 Feb 2, 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.