Fountain of Youth Rehab, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FOUNTAIN OF YOUTH REHAB, PLLC

Practice address

5260 Cedar Park Dr Ste E2
Jackson, MS 39206-4131

Phone

(601) 966-1014

Fax

(866) 598-2650

NPI assigned

Jan 7, 2022

Organization subpart

No

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

Authorized official

Name

Kimberly McNair, DPT

Title

Physical Therapist

Phone

(601) 966-1014

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1982365300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S ROACH ST APT 1004",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392012916",
            "telephone_number": "601-966-1014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5260 CEDAR PARK DR STE E2",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392064131",
            "telephone_number": "601-966-1014",
            "fax_number": "866-598-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF YOUTH REHAB, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A",
        "authorized_official_last_name": "MCNAIR",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "601-966-1014",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie E Foster, AGPCNP-C
• Penni Smith Foster, PH.D.
• Richard Kelly Foster, PHARMACIST
• Sarah Reynolds Foster, OT
• Marylin Janet Fouche, M.D.
• Candice Fountain
• Sarah Kay Fountain
• Mary K Fouquier, PHD, RN, CNM
• Four Corners Psychiatry PLLC
• Amanda Horne Fowler, M.D.

• Physical Therapist in Jackson, MS
• Providers in Jackson, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.