Fitness Clinic Wellness
NPI 1912352022ActiveOrganization· Physical Therapist· Jackson, MS
Physical Therapist in Jackson, Mississippi, registered in NPPES in April 2016. The authorized official on file is Barbara Broadwater, Executive Director. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1912352022 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 26, 2016 |
| Last updated in NPPES | Feb 9, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Psychologist, Clinical | 103TC0700X | — | — |
| Nurse Practitioner, Family | 363LF0000X | 871546 | MS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL); Part B Supplier - Clinic/Group Practice (MS) |
|---|
Other Physical Therapist providers in Jackson
- 1831473735
- 1164786588
- 1053786996
- 1508882606
- 1518177971
- 1164002432
- 1962125666
- 1053021980
- 1497027775
- 1356019954
- 1982365300
- 1912001579