Healthcare Provider Details

I. General information

NPI: 1932038460
Provider Name (Legal Business Name): JARED MATTHEW CUMBERLAND LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 IRISH HILL DR APT 28
BILOXI MS
39531-5356
US

IV. Provider business mailing address

1655 IRISH HILL DR APT 28
BILOXI MS
39531-5356
US

V. Phone/Fax

Practice location:
  • Phone: 662-352-3677
  • Fax:
Mailing address:
  • Phone: 662-352-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4141
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: