Active NPI
Professional Rehab Associates
- Physical Therapist
- McComb, MS
National Provider Identifier
1801192307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- PROFESSIONAL REHAB ASSOCIATES
- Practice address
- 1301 A Harrison Ave
McComb, MS 39648 - Phone
- (601) 250-5455
- Fax
- (601) 250-5453
- NPI assigned
- Jan 31, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Brad Wilson, DPT, ATC
- Title
- President
- Phone
- (601) 250-5455
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X |
Addresses
Primary practice location
1301 A Harrison Ave
McComb, MS 39648
Mailing address
1301 A Harrison Ave
McComb, MS 39648
Phone (601) 250-5455
Other practice location 1
631 Brookway Blvd
Brookhaven, MS 39601-2637
Phone (601) 990-2087
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01209052 | Medicaid | MS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | professionalrehab2@att.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110523000605 | MS | Part B Supplier - Clinic/Group Practice | 2567648777 |
Receives reassigned benefits from 7 practitioners Practice locations: McComb, MS; Brookhaven, MS |
| O20120313000177 | MS | DME Supplier - Independently-Practicing Physical Therapist | 2567648777 | Practice locations: McComb, MS |
National Provider Directory
National Provider DirectoryLocations
1312 Harrison Ave
Ste B
McComb, MS 39648
Phone (601) 248-2825
1301 Harrison Ave
#A
McComb, MS 39648
Phone (601) 250-5455
1301A Harrison Ave
McComb, MS 39648
Phone (601) 248-2825
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Occupational Therapist
- McComb, MS
- NPI 1093371577
MS, Occupational Therapist
-
- Occupational Therapist
- McComb, MS
- NPI 1144477233
MS, Occupational Therapist
-
- Physical Therapist
- McComb, MS
- NPI 1093359648
-
- Occupational Therapy Assistant
- McComb, MS
- NPI 1962986158
-
- Physical Therapy Assistant
- McComb, MS
- NPI 1588891717
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296432000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1559606400000",
"number": "1801192307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 A HARRISON AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-250-5455",
"fax_number": "601-250-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 A HARRISON AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-250-5455",
"fax_number": "601-250-5453"
}
],
"practiceLocations": [
{
"address_1": "631 Brookway Blvd",
"address_purpose": "LOCATION",
"city": "Brookhaven",
"state": "MS",
"postal_code": "396012637",
"country_code": "US",
"telephone_number": "601-990-2087",
"fax_number": "601-990-2081",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PROFESSIONAL REHAB ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2011-01-31",
"last_updated": "2019-06-04",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "BRAD",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "601-250-5455",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "DPT, ATC"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01209052",
"state": "MS"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "professionalrehab2@att.net",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "631 Brookway Blvd",
"city": "Brookhaven",
"state": "MS",
"country_code": "US",
"postal_code": "396012637",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; 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.