Jordan Bennett

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5517 Issued in MS

Practice address

11010 David St Ste a
Gulfport, MS 39503-3481

Phone

(228) 832-8327

NPI assigned

Jul 2, 2014

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Flex Rehabilitation & Consulting, LLC

  • Physical Therapist
  • Metairie, LA
  • NPI 1144559451
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2023.

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1194131870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11010 DAVID ST STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033481",
            "telephone_number": "228-832-8327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 DAVID ST STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033481",
            "telephone_number": "228-832-8327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-02",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT5517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald W Benefield, MD
• Jonathan Blake Benefield, CRNA
• Brenda Wakham Bennett, CFNP
• Emily Bennett
• Jeffrey L Bennett, LCSW
• Kinyatta Bennett, D.M.D.
• Robert Fortier Bensen, M.D.,N.D.,CCN
• Ashley Nicole Benson
• Caroline Benvenutti, SLP
• Brad Z. Berger, M.D.

• All providers in Gulfport, MS
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.