Provider Demographics
NPI:1205161163
Name:HOUSER, JEREMY DUANE (DPT, OCS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DUANE
Last Name:HOUSER
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S 9TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4216
Mailing Address - Country:US
Mailing Address - Phone:707-229-6141
Mailing Address - Fax:
Practice Address - Street 1:680 S 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4216
Practice Address - Country:US
Practice Address - Phone:707-229-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011697A225100000X
ALPTH5625225100000X
GAPT009785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist