GRACE MYOFASCIAL CLINIC, LLC (NPI# 1457656639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457656639 |
| Entity Type | Organization |
| Organization Name | GRACE MYOFASCIAL CLINIC, LLC |
| Practice Address |
3000 Old Canton Rd Ste 240 Jackson MS 39216-4235 |
| Practice Telephone | 6017170910 |
| Practice Fax Number | 7692576382 |
| Mailing Telephone | 6017170910 |
| Mailing Fax Number | 7692576382 |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2012-07-17 |
| Authorized Official Name | MRS. AMANDA WEILENMAN SELLERS (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 6017170910 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
PT3632 | MS | Ambulatory Health Care Facilities |
| Street Address |
3000 OLD CANTON RD STE 240 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768755 | Vanderloo Family Medicine, Pllc | Family Medicine | 3000 Old Canton Rd Ste 240, Jackson, MS 39216-4235 | 2020-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
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| 1255943098 | Jackson Hole Sports Recovery LLC | Clinic/Center | 680 S Cache St Ste 100, Jackson, WY 83001-8694 | 2020-08-22 |
| 1528690971 | Excel Therapy of Nj Corp | Clinic/Center | 2080 West Countyline Rd, Jackson, NJ 08527-0870 | 2020-02-04 |
| 1073017935 | W. A. Foote Memorial Hospital, Inc | Clinic/Center | 1100 E Michigan Ave Ste 102, Jackson, MI 49201-1800 | 2018-03-23 |
| 1023558525 | Agilitas Usa Inc | Clinic/Center | 120 District Blvd E, Suite D102, Jackson, MS 39211 | 2017-03-02 |
| 1699145490 | Inmotion Rehab, LLC | Clinic/Center | 5140 Galaxie Dr Ste 106, Jackson, MS 39206-4354 | 2015-10-06 |
| 1649613142 | Encore Rehabilitation, Inc. | Clinic/Center | 220 Hospital Dr Bldg B, Jackson, AL 36545-2459 | 2013-04-15 |
| 1730437187 | Unique Surfaces LLC | Clinic/Center | 654 Page Ave, Jackson, MI 49203-1943 | 2012-08-16 |
| 1699007658 | Andrea Marie Dillon | Clinic/Center | 120 West Pearl Avenue, Jackson, WY 83001 | 2010-02-02 |
| 1821222548 | Developmental Physical Therapy Services, LLC | Clinic/Center | 1355 Hoyt Ln, Jackson, WY 83001-9446 | 2009-05-09 |
| 1477607208 | Agilitas Usa, Inc. | Clinic/Center | 172 W University Pkwy, Ste. C, Jackson, TN 38305-1622 | 2007-01-22 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.