Southern Physical and Aquatic Therapy, P.a.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SOUTHERN PHYSICAL AND AQUATIC THERAPY, P.A.

Practice address

369 Peoples Drive
Pontotoc, MS 38863

Phone

(662) 509-0475

NPI assigned

Oct 18, 2017

Last updated

Oct 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David WashingtonNPI 1720456429

Title

Owner

Phone

(662) 509-0475

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Washington, PT

  • Physical Therapist
  • Pontotoc, MS
  • NPI 1720456429
  Medicare reassignment Authorized official
• Todd Michael Smith, RPT

  • Physical Therapist
  • Ridgeland, MS
  • NPI 1851407670
  NPD (past)

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1689185597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3161 HIGHWAY 334",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388636160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 PEOPLES DRIVE",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "38863",
            "telephone_number": "662-509-0475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PHYSICAL AND AQUATIC THERAPY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-509-0475"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Faye Skinner, NP-C
• Robin Robbins Smith, LCSW
• Denise Hefner Sojourner, MD
• South Main Dental Clinic, LLC (South Main Dental)
• Southern Light Mental Health, LLC
• Southern Pulmonary Care Services Inc
• Stegall Family Care
• Flora E Stephens
• Hope Stevens
• Stone of Hope Psychiatry & Addiction, LLC

• Physical Therapy Clinic/Center in Pontotoc, MS
• Providers in Pontotoc, 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 Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.