NPIMap

Organization Active NPI

Mississippi Spine and Pelvic Health Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Ridgeland, MS
National Provider Identifier
1710654686
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
MISSISSIPPI SPINE AND PELVIC HEALTH PHYSICAL THERAPY, LLC
Practice address
1107 Highland Colony Pkwy Ste 109
Ridgeland, MS 39157-6079
Phone
(601) 935-0766
NPI assigned
Aug 26, 2021
Last updated
Nov 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

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

Authorized official

Name
Mr. Samuel Brooks LewisNPI 1427482686
Title
Co-Owner/Coo
Phone
(601) 935-0766

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1107 Highland Colony Pkwy Ste 109
Ridgeland, MS 39157-6079

Mailing address

1107 Highland Colony Pkwy Ste 109
Ridgeland, MS 39157-6079

Other practice location 1

254 Dogwood Festival Boulevard
Suite 10
Flowood, MS 39232
Phone (601) 203-3032

Other practice location 2

1073 Highway 51 Ste 107
Madison, MS 39110-9014
Phone (601) 203-3032

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211102002958 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8325436884 Receives reassigned benefits from 15 practitioners
Practice locations: Flowood, MS; Madison, MS; Ridgeland, MS

National Provider Directory

National Provider Directory

Locations

254 Dogwood Blvd
Ste 10
Flowood, MS 39232
Phone (601) 203-3032

254 Dogwood Blvd
Unit 10
Flowood, MS 39232
Phone (601) 203-3032

1073 Highway 51
Ste 107
Madison, MS 39110
Phone (601) 203-3032

1107 Highland Colony Pkwy
Ste 109
Ridgeland, MS 39157
Phone (601) 203-3032

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762473600000",
    "number": "1710654686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 HIGHLAND COLONY PKWY STE 109",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 HIGHLAND COLONY PKWY STE 109",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576079",
            "telephone_number": "601-935-0766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "254 Dogwood Festival Boulevard",
            "address_2": "Suite 10",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "39232",
            "country_code": "US",
            "telephone_number": "601-203-3032",
            "fax_number": "601-203-3034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1073 Highway 51 Ste 107",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391109014",
            "country_code": "US",
            "telephone_number": "601-203-3032",
            "fax_number": "601-203-3034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSISSIPPI SPINE AND PELVIC HEALTH PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-26",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "BROOKS",
        "authorized_official_title_or_position": "CO-OWNER/COO",
        "authorized_official_telephone_number": "601-935-0766",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; 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.