Organization
ACTIMED, LLC
Active
Other names
Autonomy Rehab, ActiMed
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASPER WINTON ADCOCK PT, OT, RHIA (OWNER)
(601) 477-2102
Entity
Organization
Contact information
Practice address
1074 HIGHWAY 13 N, BRANDON, MS 39042-8568
(601) 825-0101
(601) 825-0102
Mailing address
48 SCR 58, MIZE, MS 39116-5703
(601) 477-2102
(601) 822-0541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5208
MS
2255A2300X
Athletic Trainer
—
MS
225700000X
Massage Therapist
—
MS
225X00000X
Occupational Therapist
2664
MS
235Z00000X
Speech-Language Pathologist
—
MS
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06529750
—
MS
05
—
3185373
—
MS
Enumeration date
03/12/2018
Last updated
08/22/2025
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