Individual
JEREMY FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
512 N SHADY LN, DOTHAN, AL 36303-2991
(334) 699-5747
Mailing address
700 FARM CREEK RD APT 245, ENTERPRISE, AL 36330-9067
(402) 957-7243
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
AL
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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