Provider Demographics
NPI:1023637402
Name:MEDICOMP PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MEDICOMP PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-391-4000
Mailing Address - Street 1:26049 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-2760
Mailing Address - Country:US
Mailing Address - Phone:662-391-4000
Mailing Address - Fax:662-391-4002
Practice Address - Street 1:26049 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2760
Practice Address - Country:US
Practice Address - Phone:662-391-4000
Practice Address - Fax:662-391-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty