NPIMap

Organization Active NPI

Metamorphosis Rehabilitation, LLC

  • Hearing and Speech Clinic/Center
  • Jackson, MS
National Provider Identifier
1497552079
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
Legal business name
METAMORPHOSIS REHABILITATION, LLC
Practice address
5170 Sunnyvale Dr
Jackson, MS 39211-4845
Phone
(909) 570-1198
NPI assigned
Feb 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Dr. Myna Laquisha Burks, PH. D.
Title
Owner/Senior Clinician
Phone
(909) 570-1198

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Home Health Agency 251E00000X
Hearing and Speech Clinic/Center 261QH0700X Primary
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X
Mobile Radiology Clinic/Center 261QR0208X

Addresses

Primary practice location

5170 Sunnyvale Dr
Jackson, MS 39211-4845

Mailing address

5170 Sunnyvale Dr
Jackson, MS 39211-4845
Phone (909) 570-1198

Other names 1

  • Metamorphosis Rehabilitation Other name

National Provider Directory

National Provider Directory
Tax ID family
Metamorphosis Rehabilitation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1497552079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 SUNNYVALE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114845",
            "telephone_number": "909-570-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5170 SUNNYVALE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114845",
            "telephone_number": "909-570-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METAMORPHOSIS REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "BURKS",
        "authorized_official_first_name": "MYNA",
        "authorized_official_middle_name": "LAQUISHA",
        "authorized_official_title_or_position": "OWNER/SENIOR CLINICIAN",
        "authorized_official_telephone_number": "909-570-1198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH. D."
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metamorphosis Rehabilitation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 28, 2025; 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.