Healthcare Provider Details

I. General information

NPI: 1780252866
Provider Name (Legal Business Name): JEREMY DUCKWORTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 KIRBY PKWY
MEMPHIS TN
38115-3721
US

IV. Provider business mailing address

3535 KIRBY PKWY
MEMPHIS TN
38115-3721
US

V. Phone/Fax

Practice location:
  • Phone: 901-365-3665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: