Provider Demographics
NPI:1396849956
Name:LASSETTER, JENIFER M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:M
Last Name:LASSETTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9725
Mailing Address - Country:US
Mailing Address - Phone:601-924-4989
Mailing Address - Fax:601-924-1888
Practice Address - Street 1:4315 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-9725
Practice Address - Country:US
Practice Address - Phone:601-924-4986
Practice Address - Fax:601-924-1888
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist