Provider Demographics
NPI:1063844595
Name:JEFFREYS, ANDREW C
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:JEFFREYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-2946
Mailing Address - Country:US
Mailing Address - Phone:662-473-4777
Mailing Address - Fax:662-473-2233
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-2946
Practice Address - Country:US
Practice Address - Phone:662-473-4777
Practice Address - Fax:662-473-2233
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist