Healthcare Provider Details

I. General information

NPI: 1275546103
Provider Name (Legal Business Name): JASON DANIEL REEVES MS,PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR SUITE 306
MADISON MS
39110-2009
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-607-7204
  • Fax: 601-607-7430
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT4077
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4077
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: