Jacob Blake Daniels, DPT
Individual provider Active NPI Physical Therapist · Brandon, MS
NPI 1295288017 · NPPES record last updated Jul 28, 2016
Key facts
- NPI
- 1295288017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT5952 (MS)
- Practice address
- 1220 N Shore Pkwy
Suite B
Brandon, MS 39047-6383 - Phone
- (601) 829-0505
- Fax
- (601) 829-0506
- NPI assigned
- Jul 28, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Drayer Physical Therapy Institute LLC | Physical Therapist | Past | Accepting new patients |
| Drayer Physical Therapy Mississippi LLC | Physical Therapist | Past | Accepting new patients |
Interoperability endpoints
- jacob.daniels.1@20428.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT5952 | MS | Yes |
Addresses
Primary practice location
1220 N Shore Pkwy
Suite B
Brandon, MS 39047-6383
Mailing address
2416 Highway 45 N
Columbus, MS 39705-1320
Phone (662) 327-6705
Other providers in Brandon, MS
- Crossgates Hma Medical Group, LLC
- James Lewis Crosthwait
- Wendy B Crumbley
- Derek Cumberland
- David A Current
- Jessica Dansby
- Jessica Deloise Darby
- Datin Medical Supply
- Datin Medical Supply
- Sky D Davenport
All providers in Brandon, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.