Healthcare Provider Details

I. General information

NPI: 1851295067
Provider Name (Legal Business Name): JALEX G HARDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5836 HIGHWAY 80
LAWRENCE MS
39336-6175
US

IV. Provider business mailing address

5836 HIGHWAY 80
LAWRENCE MS
39336-6175
US

V. Phone/Fax

Practice location:
  • Phone: 601-745-1397
  • Fax:
Mailing address:
  • Phone: 601-745-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: