Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fountain of Youth Rehab, PLLC

Organization Physical Therapist · NPI 1982365300

Fountain of Youth Rehab, PLLC is a Physical Therapist in Jackson, Mississippi. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5260 Cedar Park Dr Ste E2
Jackson, MS 39206-4131
Phone: (601) 966-1014
Fax: (866) 598-2650
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1982365300
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kimberly McNair — Physical Therapist · (601) 966-1014
NPI enumeratedJanuary 7, 2022
Last updated in NPPESOctober 10, 2022
Certification dateOctober 10, 2022
Mailing address127 S Roach St Apt 1004, Jackson, MS 39201-2916

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