Healthcare Provider Details

I. General information

NPI: 1942556311
Provider Name (Legal Business Name): JASPER WINTON ADCOCK DPT, OTR/L, RHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 HIGHWAY 13 N
BRANDON MS
39042-8568
US

IV. Provider business mailing address

48 SCR 58
MIZE MS
39116-5703
US

V. Phone/Fax

Practice location:
  • Phone: 601-825-0101
  • Fax: 16-822-0541
Mailing address:
  • Phone: 601-477-2102
  • Fax: 601-822-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5208
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5208
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2664
License Number StateMS
# 7
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2664
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: