Healthcare Provider Details

I. General information

NPI: 1780466227
Provider Name (Legal Business Name): JEROME VENTRESS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JEROME VENTRESS JR.

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 COTTONDALE DR STE 8
BATON ROUGE LA
70815-4162
US

IV. Provider business mailing address

744 N ALLYSON DR
BATON ROUGE LA
70815-4602
US

V. Phone/Fax

Practice location:
  • Phone: 225-205-1548
  • Fax:
Mailing address:
  • Phone: 225-205-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: