Magnolia Healthcare Rehabilitation Services

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MAGNOLIA HEALTHCARE REHABILITATION SERVICES

Practice address

1 Lincoln Pkwy
Suite104
Hattiesburg, MS 39402-3262

Phone

(601) 268-3292

Fax

(601) 296-2554

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Barry L. Monday

Title

Billing Admin

Phone

(601) 296-2552

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 5

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

• Robert Bishop, O.T.

  • Occupational Therapist
  • Hattiesburg, MS
  • NPI 1841385481
  NPD (past)
• Tanya Cooper

  • Physical Therapist
  • Collins, MS
  • NPI 1801003066
  NPD (past)
• Kristy S Pace, PT

  • Physical Therapist
  • Columbia, MS
  • NPI 1891735064
  NPD (past)
• Douglas Earl Peterman, RPT

  • Physical Therapist
  • Hattiesburg, MS
  • NPI 1073721528
  NPD (past)
• Kimberly C Ryder, P.T.

  • Physical Therapist
  • Hattiesburg, MS
  • NPI 1639289945
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312675200000",
    "number": "1679668784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16325",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394046325",
            "telephone_number": "601-296-2552",
            "fax_number": "601-296-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE104",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-268-3292",
            "fax_number": "601-296-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA HEALTHCARE REHABILITATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-08-07",
        "status": "A",
        "authorized_official_last_name": "MONDAY",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BILLING ADMIN",
        "authorized_official_telephone_number": "601-296-2552",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01537007",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA5495",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taniaya Magee, IDD WAIVER SERVICES
• Magnolia Analytical, LLC
• Magnolia Behavioral Psychology, PLLC
• Magnolia Brace & Rehab
• Magnolia Fireflies, LLC
• Magnolia Medical Supply Inc
• Magnolia Orthodontics
• Magnolia Sage Direct Primary Care
• Magnolia Specialty Pharmacy Inc
• Joshua A Maksi, MD

• All providers in Hattiesburg, MS
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.