Provider Demographics
NPI:1447583919
Name:HARTNETT, JO SHANNON
Entity Type:Individual
Prefix:
First Name:JO SHANNON
Middle Name:
Last Name:HARTNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WINDSOR DR N
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7091
Mailing Address - Country:US
Mailing Address - Phone:662-582-0103
Mailing Address - Fax:
Practice Address - Street 1:120 VETERANS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3578
Practice Address - Country:US
Practice Address - Phone:662-234-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist