Provider Demographics
NPI:1629367735
Name:SLAUGHTER, JANET P (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:P
Last Name:SLAUGHTER
Suffix:
Gender:F
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:PO BOX 7296
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39282-7296
Mailing Address - Country:US
Mailing Address - Phone:601-487-6930
Mailing Address - Fax:601-487-6931
Practice Address - Street 1:820 COOPER RD STE J
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4099
Practice Address - Country:US
Practice Address - Phone:601-487-6930
Practice Address - Fax:601-487-6931
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0183225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07670752Medicaid