Individual
JACOB BLAKE DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1220 N SHORE PKWY, SUITE B, BRANDON, MS 39047-6383
(601) 829-0505
(601) 829-0506
Mailing address
2416 HIGHWAY 45 N, COLUMBUS, MS 39705-1320
(662) 327-6705
(662) 327-6760
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5952
MS
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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