Active NPI
Kim Viverette
- Physical Therapist
- Philadelphia, MS
National Provider Identifier
1780032110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT633
- Practice address
- 1001 Holland Ave
Philadelphia, MS 39350-2161 - Phone
- (601) 663-1484
- NPI assigned
- May 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT633 | MS | Primary |
Addresses
Primary practice location
1001 Holland Ave
Philadelphia, MS 39350-2161
Mailing address
4109 Highway 98 W
Summit, MS 39666-9132
Phone (601) 276-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT633 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464220800000",
"number": "1780032110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4109 HIGHWAY 98 W",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396669132",
"telephone_number": "601-276-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 HOLLAND AVE",
"city": "PHILADELPHIA",
"state": "MS",
"postal_code": "393502161",
"telephone_number": "601-663-1484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIVERETTE",
"first_name": "KIM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-26",
"last_updated": "2016-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.