Healthcare Provider Details

I. General information

NPI: 1609973866
Provider Name (Legal Business Name): JANE WALDROP P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5132 BEATLINE RD SUITE D
LONG BEACH MS
39560-3869
US

IV. Provider business mailing address

PO BOX 8419
BILOXI MS
39535-8087
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-8429
  • Fax: 228-575-8891
Mailing address:
  • Phone: 228-688-5714
  • Fax: 228-388-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3758
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0185
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: