Provider Demographics
NPI:1518398833
Name:MEDICOMP, INC
Entity Type:Organization
Organization Name:MEDICOMP, INC
Other - Org Name:AMORY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-849-6440
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-0426
Mailing Address - Country:US
Mailing Address - Phone:601-849-6440
Mailing Address - Fax:601-849-6443
Practice Address - Street 1:1506 HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5918
Practice Address - Country:US
Practice Address - Phone:662-304-4026
Practice Address - Fax:662-256-5069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICOMP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty