Jennifer Mardis Durley, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3716 Issued in MS

Practice address

5600 Goodman Rd Ste D
Olive Branch, MS 38654-7002

Phone

(662) 895-4545

Fax

(662) 895-4545

NPI assigned

Jul 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Jennifer Robin Mardis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467473371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 GOODMAN RD STE D",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547002",
            "telephone_number": "662-895-4545",
            "fax_number": "662-895-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 GOODMAN RD STE D",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547002",
            "telephone_number": "662-895-4545",
            "fax_number": "662-895-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURLEY",
        "first_name": "JENNIFER",
        "middle_name": "MARDIS",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT3716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05101748",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MARDIS",
            "middle_name": "ROBIN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diane Marie Donohue, M.D.
• Stephanie Machelle Douglass, PMHNP-BC
• Dream Team Family Dentistry, PLLC
• Drive Right, LLC
• Colton Dunn, FNP-C
• East Park Counseling Services LLC
• Edward Burris Eldred, D.O.
• Elite Practice Management
• Ashley Ellis, PHARM.D.
• Tina Ellis, APRN

• Physical Therapist in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.