Provider Demographics
NPI:1275546103
Name:REEVES, JASON DANIEL (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:REEVES
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-3205
Practice Address - Street 1:401 BAPTIST DR
Practice Address - Street 2:SUITE 306
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2009
Practice Address - Country:US
Practice Address - Phone:601-607-7204
Practice Address - Fax:601-607-7430
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4077174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7752862OtherAETNA
MSPT4077OtherMS BOARD CERTIFICATION #
MSPT4077OtherMS BOARD CERTIFICATION #
MS7752862OtherAETNA