Provider Demographics
NPI:1366985608
Name:HARVEY, JEREMY (DPT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 POST OAK PL
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5534
Mailing Address - Country:US
Mailing Address - Phone:601-955-9980
Mailing Address - Fax:
Practice Address - Street 1:2015 HIGHPOINTE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3169
Practice Address - Country:US
Practice Address - Phone:888-976-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist