| Fitness Clinic Wellness | |
|
2219 Greenway Dr Jackson MS 39204-3202 | |
| (601) 983-7494 | |
| Not Available |
| Full Name | Fitness Clinic Wellness |
|---|---|
| Speciality | Physical Therapist |
| Location | 2219 Greenway Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Barbara Broadwater (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6019837494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fitness Clinic Wellness 2219 Greenway Dr Jackson MS 39204-3202 Ph: (601) 983-7494 | Fitness Clinic Wellness 2219 Greenway Dr Jackson MS 39204-3202 Ph: (601) 983-7494 |
| NPI Number | 1912352022 |
|---|---|
| Provider Enumeration Date | 04/26/2016 |
| Last Update Date | 02/09/2017 |
| Medicare PECOS PAC ID | 4486938719 |
|---|---|
| Medicare Enrollment ID | O20170303001462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912352022 | NPI | - | NPPES |
| Provider Name | Theresia Johnson Ratliff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154639045 PECOS PAC ID: 3476528647 Enrollment ID: I20040831000953 |
| Provider Name | Marion C Ross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992709570 PECOS PAC ID: 7618945965 Enrollment ID: I20040923000753 |
| Provider Name | Darryl Wheat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194877068 PECOS PAC ID: 0446389605 Enrollment ID: I20100526000410 |
| Provider Name | Linda Marie Vance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174751093 PECOS PAC ID: 8820280274 Enrollment ID: I20101104000674 |
| Provider Name | Kenyatta N Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457633034 PECOS PAC ID: 5799943106 Enrollment ID: I20120214000728 |
| Provider Name | Amanda Carson-griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124456850 PECOS PAC ID: 8022247527 Enrollment ID: I20140203001154 |
| Provider Name | Ruth A Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609270123 PECOS PAC ID: 2668796475 Enrollment ID: I20150128000194 |
| Provider Name | Ruth Drake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346536158 PECOS PAC ID: 4486971488 Enrollment ID: I20150401001751 |
| Provider Name | Jamie Stokes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1336530914 PECOS PAC ID: 1850611161 Enrollment ID: I20150527001867 |
| Provider Name | Nelda Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801288410 PECOS PAC ID: 6002110756 Enrollment ID: I20160201002118 |
| Provider Name | Arlene Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659721116 PECOS PAC ID: 5597043018 Enrollment ID: I20161103000140 |
| Provider Name | James O Farrell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003116062 PECOS PAC ID: 1355627456 Enrollment ID: I20170403002297 |
| Provider Name | Jasmine Martin Smith |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679863245 PECOS PAC ID: 4789952979 Enrollment ID: I20171209000085 |
| Provider Name | Venessia Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437640463 PECOS PAC ID: 6103166830 Enrollment ID: I20190315002478 |
| Provider Name | Kendria Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437645017 PECOS PAC ID: 3971936436 Enrollment ID: I20191214000195 |
| Provider Name | Jacqueline Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700461456 PECOS PAC ID: 0547660201 Enrollment ID: I20210617000168 |
| Provider Name | Glenda Neighbors Mcconnell |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053550806 PECOS PAC ID: 7214333137 Enrollment ID: I20210901001120 |
| Provider Name | Kimberly Walker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891303699 PECOS PAC ID: 2769888577 Enrollment ID: I20210902001200 |
| Provider Name | Jacqueline A Fleming |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043526643 PECOS PAC ID: 8123417714 Enrollment ID: I20211122000371 |
| Provider Name | Suzanne Vanderkooi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518270941 PECOS PAC ID: 4981832250 Enrollment ID: I20220920002134 |
| Provider Name | Katie Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477277036 PECOS PAC ID: 7810363074 Enrollment ID: I20221013001958 |
| Provider Name | Melissa Victoria Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811486202 PECOS PAC ID: 7416368584 Enrollment ID: I20221129000695 |
| Provider Name | Rosetta Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922107366 PECOS PAC ID: 9638549124 Enrollment ID: I20221227001116 |
| Provider Name | Latonyia Hewett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417281908 PECOS PAC ID: 4082739974 Enrollment ID: I20230727001658 |
| Provider Name | Alicia Hopkins |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518357284 PECOS PAC ID: 2567789506 Enrollment ID: I20231004000556 |
| Provider Name | Heidi D Hollis |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699188300 PECOS PAC ID: 0244605434 Enrollment ID: I20240405003344 |
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