Individual
MR. JASON DANIEL REEVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS,PT
Contact information
Practice address
401 BAPTIST DR, SUITE 306, MADISON, MS 39110-2009
(601) 607-7204
(601) 607-7430
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-3205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PT4077
MS
225100000X
Physical Therapist
Primary
PT4077
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7752862
AETNA
MS
01
—
PT4077
MS BOARD CERTIFICATION #
MS
Enumeration date
08/14/2006
Last updated
03/15/2018
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