NPIMap

Organization Active NPI

Ethos Rehab LLC

  • Physical Therapist
  • Madison, MS
National Provider Identifier
1528351798
Registry record updated May 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT2014 Issued in MS
Legal business name
ETHOS REHAB LLC
Practice address
100 Selby Dr
Madison, MS 39110-9437
Phone
(601) 946-8558
Fax
(601) 707-7408
NPI assigned
May 22, 2011
Last updated
May 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2011

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

Authorized official

Name
Clay J Eckerson, PT
Title
Owner
Phone
(601) 946-8558

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT2014 MS Primary

Addresses

Primary practice location

100 Selby Dr
Madison, MS 39110-9437

Mailing address

100 Selby Dr
Madison, MS 39110-9437
Phone (601) 946-8558

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1306022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306022400000",
    "number": "1528351798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SELBY DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109437",
            "telephone_number": "601-946-8558",
            "fax_number": "601-707-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SELBY DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109437",
            "telephone_number": "601-946-8558",
            "fax_number": "601-707-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHOS REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-22",
        "last_updated": "2011-05-22",
        "status": "A",
        "authorized_official_last_name": "ECKERSON",
        "authorized_official_first_name": "CLAY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-946-8558",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT2014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2011; 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.