Provider Demographics
NPI:1225291271
Name:DORROH, JESSE A (DPT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:A
Last Name:DORROH
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 1:65 EARLY GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-6002
Mailing Address - Country:US
Mailing Address - Phone:662-258-3332
Mailing Address - Fax:662-258-3356
Practice Address - Street 1:65 EARLY GROVE AVE
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-6002
Practice Address - Country:US
Practice Address - Phone:662-258-3332
Practice Address - Fax:662-258-3356
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1225291271OtherNPI NUMBER