NPIMap

Organization Active NPI

Grenada Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Grenada, MS
National Provider Identifier
1952498552
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT2219 Issued in MS
Legal business name
GRENADA PHYSICAL THERAPY, INC
Practice address
601 Old Hickory Rd
Ste a
Grenada, MS 38901-4086
Phone
(662) 227-9748
Fax
(662) 227-9769
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Authorized official

Name
Mr. Charles Edward Hill II, P.T.NPI 1225200280
Title
Owner
Phone
(662) 227-9748

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 PT2219 MS Primary

Addresses

Primary practice location

601 Old Hickory Rd
Ste a
Grenada, MS 38901-4086

Mailing address

PO Box 278
Grenada, MS 38902-0278
Phone (662) 227-9748

Other identifiers 1

IdentifierTypeStateIssuer
09016043MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Grenada

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930093287 MS DME Supplier - Independently-Practicing Physical Therapist 5395940753 Practice locations: Grenada, MS
O20111024000273 MS Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5395940753 Practice locations: Grenada, MS

National Provider Directory

National Provider Directory

Locations

601 Old Hickory Rd
#A
Grenada, MS 38901
Phone (662) 227-9748

1300 Sunset Dr
Ste G
Grenada, MS 38901
Phone (662) 227-9748

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1952498552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389020278",
            "telephone_number": "662-227-9748",
            "fax_number": "662-227-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 OLD HICKORY RD",
            "address_2": "STE A",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014086",
            "telephone_number": "662-227-9748",
            "fax_number": "662-227-9769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-227-9748",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MS",
            "license": "PT2219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016043",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Grenada",
            "affiliation": "N",
            "address_1": "601 Old Hickory Rd, Ste. A",
            "city": "Grenada",
            "state": "MS",
            "country_code": "US",
            "postal_code": "38901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grenada, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.

Verify at the official NPI Registry.