Individual
JEREMY A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7127 HIGHWAY 98 WEST, SUITE 40, HATTIESBURG, MS 39402
(601) 261-1550
(601) 268-2530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-1550
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4051
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00237896
—
MS
01
—
0463784
CIGNA
MS
01
—
3451245
UNITED HEALTHCARE
MS
01
—
9007864
AETNA
MS
01
—
P01206663
RAILROAD MEDICARE
MS
Enumeration date
11/02/2010
Last updated
08/23/2016
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