Provider Demographics
NPI:1669485926
Name:HELTON, JASON D (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:HELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-794-2402
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:98 SHELBY SPEIGHTS DR
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-4528
Practice Address - Country:US
Practice Address - Phone:601-794-2402
Practice Address - Fax:601-794-2404
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640507572PEOtherAMERICAN ADMIN GROUP
MS01572755Medicaid
P00199191OtherRAILROAD MEDICARE
MS640507572PEOtherAMERICAN ADMIN GROUP
MS01572755Medicaid