John S Petrides

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3548 Issued in MS

Practice address

5699 Getwell Rd
Building E, Suite 2
Southaven, MS 38672-7312

Phone

(662) 349-6712

NPI assigned

May 20, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• First State Rehab at Home, LLC

  • Physical Therapist
  • Wilmington, DE
  • NPI 1407229677
  Medicare reassignment

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274313600000",
    "number": "1982923652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2385 APPLETON DR",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727105",
            "telephone_number": "662-449-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5699 GETWELL RD",
            "address_2": "BUILDING E, SUITE 2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727312",
            "telephone_number": "662-349-6712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIDES",
        "first_name": "JOHN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-20",
        "last_updated": "2010-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT3548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE: MISSISSIPPI",
            "identifier": "PT3548",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Turner Donaldson Peckham
• Airreal Pegues, MS
• Madison Grace Pena, PTA
• Jennifer Petell, PH.D IN CLINICAL PSY
• Calleen Patricia Petersen, LMSW
• Tracey F Petrides, M.D.
• Blanche Foshee' Petty, APRN
• Pharmcare USA of Memphis, Inc
• Phase2 Labs Mississippi LLC
• Phillips County Transportation

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.