# ACTIMED, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Autonomy Rehab, ActiMed
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386147817
- **Authorized official:** DR. JASPER WINTON ADCOCK PT, OT, RHIA (OWNER)
- **Authorized official phone:** (601) 477-2102

## Contact information

- **Practice address:** 1074 HIGHWAY 13 N, BRANDON, MS 39042-8568
- **Practice address phone:** (601) 825-0101
- **Practice address fax:** (601) 825-0102
- **Mailing address:** 48 SCR 58, MIZE, MS 39116-5703
- **Mailing address phone:** (601) 477-2102
- **Mailing address fax:** (601) 822-0541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 5208 | MS | Yes |
| 2255A2300X | Athletic Trainer | — | MS | — |
| 225700000X | Massage Therapist | — | MS | — |
| 225X00000X | Occupational Therapist | 2664 | MS | — |
| 235Z00000X | Speech-Language Pathologist | — | MS | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/12/2018
- **Last updated:** 08/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 06529750 | — | MS |
| 05 | — | 3185373 | — | MS |