Individual
JASEN SISSON ABRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
(662) 328-1507
Mailing address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
(662) 328-1507
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4914
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00080755
—
MS
01
—
1598051112
NATIONAL PROVIDER NUMBER
MS
Enumeration date
06/22/2011
Last updated
06/18/2015
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