Healthcare Provider Details

I. General information

NPI: 1982103131
Provider Name (Legal Business Name): JESSICA LEWIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LASHUN BROWNLOW

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BAKER BLVD
LELAND MS
38756-3401
US

IV. Provider business mailing address

8331 STONECREST DR E
OLIVE BRANCH MS
38654-0507
US

V. Phone/Fax

Practice location:
  • Phone: 662-686-4121
  • Fax: 662-686-4770
Mailing address:
  • Phone: 662-299-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11368
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6806
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: