Healthcare Provider Details

I. General information

NPI: 1194631226
Provider Name (Legal Business Name): JEREMY RANKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

IV. Provider business mailing address

4213 ROBINSON AVE
MOSS POINT MS
39563-2724
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-9363
  • Fax:
Mailing address:
  • Phone: 228-875-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8092
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: